*Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; †Department of Biochemistry and Molecular Biology, Institute of Biomedicine (IBUB), University of Barcelona, Barcelona, Spain; ‡CIBER Fisiopatologia de la Obesidad y Nutrición, Barcelona, Spain; §Biostatistics and Data Management Platform, IDIBAPS, Hospital Clinic; Biostatistics Unit, School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; and ‖Infectious Diseases Unit, Department of Internal Medicine, Hospital Universitari Joan XXIII, IISPV, Universitat Rovira i Virgili, Tarragona, Spain.
J Acquir Immune Defic Syndr. 2014 Aug 15;66(5):457-65. doi: 10.1097/QAI.0000000000000205.
Conflicting reports on the effects of efavirenz (EFV) and lopinavir/ritonavir (LPV/r) on subcutaneous adipose tissue (SAT) have been described.
The aim was to assess the 48-week molecular and clinical effects of LPV/r and EFV, combined with tenofovir/emtricitabine (TDF/FTC), on SAT of HIV-infected, antiretroviral-naive patients.
Forty-four adults were started on LPV/r or EFV combined with TDF/FTC. Fasting metabolic tests, HIV RNA, CD4 cell count, and fat measured by dual x-ray absorptiometry scans were obtained at study entry and week 48. Mitochondrial DNA (mtDNA) and transcripts for mtDNA-encoded proteins and genes involved in inflammation, adipocyte differentiation, and metabolism were assessed in paired SAT biopsies.
Whole-body fat and limb fat mass increased in the LPV/r and EFV groups. MtDNA and cytochrome oxidase subunit II did not change, and cytochrome b increased significantly in EFV-treated patients. Tumor necrosis factor alpha and monocyte chemotactic protein-1 gene expression did not change in the LPV/r group, but these significantly increased in the EFV group. Interleukin 18 decreased in the LPV/r group, whereas it increased in the EFV group.
Starting TDF/FTC plus EFV was associated with an increased expression of genes encoding for inflammatory cytokines in SAT in naive patients. Therapy with TDF/FTC plus LPV/r or EFV was associated with an increase in subcutaneous fat mass.
已有报告称，依非韦伦（EFV）和洛匹那韦/利托那韦（LPV/r）对皮下脂肪组织（SAT）的影响相互矛盾。
评估 LPV/r 和 EFV 联合替诺福韦/恩曲他滨（TDF/FTC）治疗 48 周对初治 HIV 感染患者 SAT 的分子和临床影响。
44 例成人开始接受 LPV/r 或 EFV 联合 TDF/FTC 治疗。在研究入组时和第 48 周，进行空腹代谢试验、HIV RNA、CD4 细胞计数和双能 X 线吸收法扫描测量的脂肪。评估配对 SAT 活检中 mtDNA 及其编码蛋白和参与炎症、脂肪细胞分化和代谢的 mtDNA 转录物。
LPV/r 和 EFV 组全身脂肪和四肢脂肪质量增加。mtDNA 和细胞色素氧化酶亚基 II 没有变化，EFV 治疗组细胞色素 b 显著增加。LPV/r 组肿瘤坏死因子-α和单核细胞趋化蛋白-1 基因表达没有变化，但 EFV 组明显增加。LPV/r 组白细胞介素 18 减少，而 EFV 组增加。
初治患者开始接受 TDF/FTC 联合 EFV 治疗与 SAT 中编码炎症细胞因子的基因表达增加有关。TDF/FTC 联合 LPV/r 或 EFV 治疗与皮下脂肪质量增加有关。
