HIV/丙型肝炎病毒合并感染可改善 HIV 感染的致动脉粥样硬化脂蛋白异常。
HIV/hepatitis C virus coinfection ameliorates the atherogenic lipoprotein abnormalities of HIV infection.
机构信息
aDepartment of Medicine, University of California San Francisco bDivision of Endocrinology and Metabolism, Department of Veterans Affairs Medical Center San Francisco, San Francisco cDepartment of Medicine, University of California, San Diego School of Medicine, San Diego, California dDepartment of Epidemiology, University of Washington, Seattle, Washington eDepartment of Epidemiology and Biostatistics, University of California San Francisco, San Francisco fDivision of Research, Kaiser Permanente, Oakland, California, USA.
出版信息
AIDS. 2014 Jan 2;28(1):49-58. doi: 10.1097/QAD.0000000000000026.
BACKGROUND
Higher levels of small low-density lipoprotein (LDL) and lower levels of high-density lipoprotein (HDL) subclasses have been associated with increased risk of cardiovascular disease. The extent to which HIV infection and HIV/hepatitis C virus (HCV) coinfection are associated with abnormalities of lipoprotein subclasses is unknown.
METHODS
Lipoprotein subclasses were measured by nuclear magnetic resonance (NMR) spectroscopy in plasma samples from 569 HIV-infected and 5948 control participants in the Fat Redistribution and Metabolic Change in HIV Infection (FRAM), Coronary Artery Risk Development in Young Adults (CARDIA), and Multi-Ethnic Study of Atherosclerosis (MESA) studies. Multivariable regression was used to estimate the association of HIV and HIV/HCV coinfection with lipoprotein measures with adjustment for demographics, lifestyle factors, and waist-to-hip ratio.
RESULTS
Relative to controls, small LDL levels were higher in HIV-monoinfected persons (+381 nmol/l, P <0.0001), with no increase seen in HIV/HCV coinfection (-16.6 nmol/l). Levels of large LDL levels were lower (-196 nmol/l, P <0.0001) and small HDL were higher (+8.2 μmol/l, P < 0.0001) in HIV monoinfection with intermediate values seen in HIV/HCV coinfection. Large HDL levels were higher in HIV/HCV-coinfected persons relative to controls (+1.70 μmol/l, P <0.0001), whereas little difference was seen in HIV-monoinfected persons (+0.33, P = 0.075). Within HIV-infected participants, HCV was associated independently with lower levels of small LDL (-329 nmol/l, P <0.0001) and small HDL (-4.6 μmol/l, P <0.0001), even after adjusting for demographic and traditional cardiovascular risk factors.
CONCLUSION
HIV-monoinfected participants had worse levels of atherogenic LDL lipoprotein subclasses compared with controls. HIV/HCV coinfection attenuates these changes, perhaps by altering hepatic factors affecting lipoprotein production and/or metabolism. The effect of HIV/HCV coinfection on atherosclerosis and the clinical consequences of low small subclasses remain to be determined.
背景
小而密的低密度脂蛋白（LDL）水平升高和高密度脂蛋白（HDL）亚类水平降低与心血管疾病风险增加相关。HIV 感染以及 HIV/丙型肝炎病毒（HCV）合并感染与脂蛋白亚类异常的关联程度尚不清楚。
方法
采用磁共振（NMR）光谱法在感染 HIV 的 569 名参与者和对照的 5948 名参与者的血浆样本中测量脂蛋白亚类。多变量回归用于估计 HIV 和 HIV/HCV 合并感染与脂蛋白测量的相关性，调整了人口统计学、生活方式因素和腰围臀围比。
结果
与对照组相比，HIV 单一感染者的小 LDL 水平较高（+381nmol/L，P<0.0001），而 HIV/HCV 合并感染者未见增加（-16.6nmol/L）。大 LDL 水平较低（-196nmol/L，P<0.0001），小 HDL 水平较高（+8.2μmol/L，P<0.0001），而 HIV/HCV 合并感染者处于中间水平。与对照组相比，HIV/HCV 合并感染者的大 HDL 水平较高（+1.70μmol/L，P<0.0001），而 HIV 单一感染者的水平差异较小（+0.33，P=0.075）。在 HIV 感染者中，HCV 独立与小 LDL 水平降低（-329nmol/L，P<0.0001）和小 HDL 水平降低（-4.6μmol/L，P<0.0001）相关，即使在调整了人口统计学和传统心血管危险因素后也是如此。
结论
与对照组相比，HIV 单一感染者的致动脉粥样硬化 LDL 脂蛋白亚类水平更差。HIV/HCV 合并感染减轻了这些变化，这可能是通过改变影响脂蛋白生成和/或代谢的肝脏因素。HIV/HCV 合并感染对动脉粥样硬化的影响以及低小亚类的临床后果仍有待确定。
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