Hejazi Nazisa, Rajikan Roslee, Choong Christopher Lee Kwok, Sahar Suzana
Dietetics Program, School of Health Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, 50300, Malaysia.
BMC Public Health. 2013 Aug 15;13:758. doi: 10.1186/1471-2458-13-758.
In the current two decades, dyslipidemia and increased blood glucose as metabolic abnormalities are the most common health threats with a high incidence among HIV/AIDS patients on antiretroviral (ARV) treatment. Scientific investigations and reports on lipid and glucose disorders among HIV infected communities are inadequate especially in those developing such as Malaysia. This cross-sectional survey was mainly aimed to evaluate the prevalence of metabolic abnormalities and associated risk factors among HIV infected population patients on ARV medication.
In a single reference health center in Malaysia, 2739 adult HIV positive patients on antiretroviral therapy (ART) were studied cross-sectionally using medical records. Besides demographic variables and associated health disorders, those factors which can change the lipid and glucose levels were collected. Logistic Regression was used to find the potential risk factors (p < 0.05).
Majority of the studied population were male (81.1%) and aged between 30-49 (68.6%). Mean CD4 count was 474.25 (cells/mm3) while undetectable RNA viral load was common among 83.3 (%) of subjects. Among 1,583 patients with the recent blood lipid and glucose tests, increased levels of triglyceride (TG) and total cholesterol (TC) were frequently prevalent in half of the population as 59 (%) and 54.2 (%) while 28.7 (%), 35.1 (%) and 38.2 (%) had declined level of high-density lipoprotein (HDL), raised low-density lipoprotein (LDL) and fasting plasma glucose (FPG) which were less common. Dyslipidemia was common in 82.3 (%) of the subjects. Notably, medication with protease inhibitor (PI) was a potential risk for elevated triglyceride (odds ratio (OR) = 2.309, 95% confidence interval (CI) = 1.605-3.324, P = 0.001), high TC (OR = 1.561, 95% CI = 1.123-2.169, P = 0.008) and low HDL (OR = 1.449, 95% CI = 1.037-2.024, P = 0.029). As lifestyle factor, alcohol consumption results as significant risk factor for raised TG (OR = 2.653, 95% CI = 1.353-5.202, P = 0.004). Also having hepatitis raised risk of high FPG level (OR = 1.630, 95% CI = 1.197-2.220, P = 0.002) in this sample population.
Dyslipidemia is highly common in Malaysian HIV subjects receiving ARV medication. Lifestyle modification, changing PI and switch to other ARV regimen can help in reduction of these abnormalities. Also suitable strategies and plans are necessary to prevent cardiovascular diseases in future.
在过去二十年中，血脂异常和血糖升高作为代谢异常，是接受抗逆转录病毒（ARV）治疗的艾滋病毒/艾滋病患者中最常见的健康威胁，发病率很高。关于艾滋病毒感染群体中脂质和葡萄糖紊乱的科学调查和报告不足，尤其是在马来西亚等发展中国家。这项横断面调查主要旨在评估接受ARV药物治疗的艾滋病毒感染人群中代谢异常的患病率及相关危险因素。
在马来西亚的一个单一参考健康中心，对2739名接受抗逆转录病毒治疗（ART）的成年艾滋病毒阳性患者进行了横断面研究，使用医疗记录。除了人口统计学变量和相关健康疾病外，还收集了那些可能改变脂质和血糖水平的因素。采用逻辑回归分析来确定潜在危险因素（p < 0.05）。
研究人群中大多数为男性（81.1%），年龄在30 - 49岁之间（68.6%）。平均CD4细胞计数为474.25（细胞/mm³），而83.3%的受试者中常见病毒载量不可检测。在1583名近期进行血脂和血糖检测的患者中，甘油三酯（TG）和总胆固醇（TC）水平升高在一半人群中较为常见，分别为59%和54.2%，而高密度脂蛋白（HDL）水平降低、低密度脂蛋白（LDL）升高和空腹血糖（FPG）升高的情况较少见，分别为28.7%、35.1%和38.2%。血脂异常在82.3%的受试者中常见。值得注意的是，使用蛋白酶抑制剂（PI）是甘油三酯升高（比值比（OR）= 2.309，95%置信区间（CI）= 1.605 - 3.324，P = 0.001）、总胆固醇升高（OR = 1.561，95% CI = 1. 123 - 2.169，P = 0.008）和高密度脂蛋白降低（OR = 1.449，95% CI = 1.037 - 2.024，P = 0.029）的潜在危险因素。作为生活方式因素，饮酒是甘油三酯升高的显著危险因素（OR = 2.653，95% CI = 1.353 - 5.202，P = 0.004）。在该样本人群中，患有肝炎也会增加空腹血糖水平升高的风险（OR = 1.630，95% CI = 1.197 - 2.220，P = 0.002）。
在接受ARV药物治疗的马来西亚艾滋病毒感染者中，血脂异常非常普遍。改变生活方式、更换PI并改用其他ARV治疗方案有助于减少这些异常情况。此外，未来有必要制定合适策略和计划以预防心血管疾病。
