Monroe Anne K, Fu Wei, Zikusoka Michelle N, Jacobson Lisa P, Witt Mallory D, Palella Frank J, Kingsley Lawrence A, Post Wendy S, Brown Todd T
1Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
2Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
AIDS Res Hum Retroviruses. 2015 Jun;31(6):593-602. doi: 10.1089/AID.2014.0126. Epub 2015 Mar 9.
Treating cardiovascular disease (CVD) risk factors, including dyslipidemia, is important in HIV care. Low-density lipoprotein cholesterol (LDL-c) target achievement is a readily available benchmark for dyslipidemia control, although use of this target is not uniformly endorsed by professional societies. We examined whether HIV serostatus is associated with not achieving LDL-c target. Among Multicenter AIDS Cohort Study (MACS) participants completing visit 56 (10/1/2011-3/31/2012), we categorized each man as on or off statin therapy and used NCEP ATP III guidelines to determine if each man was at LDL-c target or not at target. We compared proportions of men not at target and determined predictors using multivariate logistic regression. Sixty of 543 (11.1%) HIV-infected men and 87 of 585 (14.9%) HIV-uninfected men not receiving statin therapy were not at target (p=0.07), while 31 of 230 (13.5%) HIV-infected and 29 of 204 (14.2%) HIV-uninfected men receiving statin therapy were not at target (p=0.82). Factors associated with not being at target (among men not receiving statin therapy) included current smoking (OR=2.31, 95% CI 1.31, 4.06) and a diagnosis of hypertension (OR=4.69, 95% CI 2.68, 8.21). Factors associated with not being at target (among men receiving statin therapy) included current smoking (OR=2.72, 95% CI 1.30, 5.67) and diabetes (OR=5.31, 95% CI 2.47, 11.42). HIV-infected and HIV-uninfected men receiving statin therapy demonstrated similar nonachievement of LDL-c targets. Comorbidities (e.g., diabetes) lowered targets and may explain why goals were less likely to be met.
在艾滋病护理中，治疗包括血脂异常在内的心血管疾病（CVD）风险因素非常重要。低密度脂蛋白胆固醇（LDL-c）目标达成情况是血脂异常控制的一个现成基准，尽管专业学会对该目标的使用并未得到一致认可。我们研究了HIV血清学状态是否与未达成LDL-c目标相关。在完成第56次访视（2011年10月1日至2012年3月31日）的多中心艾滋病队列研究（MACS）参与者中，我们将每名男性分为接受或未接受他汀类药物治疗，并使用美国国家胆固醇教育计划成人治疗组第三次报告（NCEP ATP III）指南来确定每名男性是否达到LDL-c目标。我们比较了未达目标男性的比例，并使用多变量逻辑回归确定预测因素。在未接受他汀类药物治疗的543名HIV感染男性中，有60名（11.1%）未达目标，在585名未感染HIV的男性中有87名（14.9%）未达目标（p=0.07），而在接受他汀类药物治疗的230名HIV感染男性中有31名（13.5%）未达目标，在204名未感染HIV的男性中有29名（14.2%）未达目标（p=0.82）。与未达目标相关的因素（在未接受他汀类药物治疗的男性中）包括当前吸烟（比值比[OR]=2.31，95%置信区间[CI] 1.31，4.06）和高血压诊断（OR=4.69，95% CI 2.68，8.21）。与未达目标相关的因素（在接受他汀类药物治疗的男性中）包括当前吸烟（OR=2.72，95% CI 1.30，5.67）和糖尿病（OR=5.31，95% CI 2.47，11.42）。接受他汀类药物治疗的HIV感染男性和未感染HIV的男性在LDL-c目标未达成方面表现相似。合并症（如糖尿病）降低了目标达成率，这可能解释了为何目标达成的可能性较低。
