Shen Yinzhong, Wang Jiangrong, Wang Zhenyan, Qi Tangkai, Song Wei, Tang Yang, Liu Li, Zhang Renfang, Lu Hongzhou
From the Department of Infectious Disease, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China (YS, JW, ZW, TQ, WS, YT, LL, RZ, HL).
Medicine (Baltimore). 2015 Dec;94(48):e2201. doi: 10.1097/MD.0000000000002201.
Little is known about the epidemiological features of dyslipidemia among antiretroviral-naive HIV-infected individuals in China. We used a cross-sectional study design to estimate the prevalence of dyslipidemia in this population, and to identify risk factors associated with the presence of dyslipidemia. One thousand five hundred and eighteen antiretroviral-naive HIV-infected individuals and 347 HIV-negative subjects in China were enrolled during 2009 to 2010. Demographics and medical histories were recorded. After an overnight fast, serum samples were collected to measure lipid levels. Factors associated with the presence of dyslipidemia were analyzed by logistic regression. Mean total cholesterol (TC), low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL) levels were lower in HIV-positive than HIV-negative subjects, but mean triglyceride (TG) was higher in HIV-positive subjects. The overall prevalence of dyslipidemia in HIV-positive and HIV-negative groups did not differ (75.6% vs. 73.7%, P = 0.580). However, the prevalence of high TC (8.4% vs. 28.2%, P < 0.001) and high LDL (8.5% vs. 62.6%, P < 0.001) was lower in HIV-positive than HIV-negative subjects, and the prevalence of high TG (33.9% vs. 17.0%, P < 0.001) and low HDL (59.6% vs. 11.2%, P < 0.001) was higher in HIV-positive than HIV-negative subjects. Logistic analysis showed that HIV positivity was significantly associated with both an increased risk of high TG and low HDL and a decreased risk of high TC and high LDL. The mean levels of TC, of LDL and of HDL showed an increasing trend with increasing CD4 count in HIV-positive subjects. Multivariable logistic regression found that lower CD4 count was significantly associated with both an increased risk of high TG and low HDL and a decreased risk of high TC in HIV-positive subjects. Among antiretroviral-naive HIV-infected Chinese adults, there was a high prevalence of dyslipidemia characterized by high TG and low HDL, which was associated with lower CD4 counts. These data support the assessment of lipid profiles before and after initiation of antiretroviral therapy regardless of age.
在中国,对于初治的HIV感染者中血脂异常的流行病学特征知之甚少。我们采用横断面研究设计来估计该人群中血脂异常的患病率,并确定与血脂异常存在相关的危险因素。2009年至2010年期间,在中国招募了1518名初治的HIV感染者和347名HIV阴性受试者。记录了人口统计学和病史。经过一夜禁食后,采集血清样本以测量血脂水平。通过逻辑回归分析与血脂异常存在相关的因素。HIV阳性受试者的平均总胆固醇(TC)、低密度脂蛋白胆固醇(LDL)、高密度脂蛋白胆固醇(HDL)水平低于HIV阴性受试者,但HIV阳性受试者的平均甘油三酯(TG)更高。HIV阳性组和HIV阴性组血脂异常的总体患病率无差异(75.6%对73.7%,P = 0.580)。然而,HIV阳性受试者中高TC(8.4%对28.2%,P < 0.001)和高LDL(8.5%对62.6%,P < 0.001)的患病率低于HIV阴性受试者,而HIV阳性受试者中高TG(33.9%对17.0%,P < 0.001)和低HDL(59.6%对11.2%,P < 0.001)的患病率高于HIV阴性受试者。逻辑分析表明,HIV阳性与高TG和低HDL风险增加以及高TC和高LDL风险降低均显著相关。在HIV阳性受试者中,TC、LDL和HDL的平均水平随CD4计数增加呈上升趋势。多变量逻辑回归发现,较低的CD4计数与HIV阳性受试者中高TG和低HDL风险增加以及高TC风险降低均显著相关。在初治的HIV感染中国成年人中,以高TG和低HDL为特征的血脂异常患病率较高,这与较低的CD4计数有关。这些数据支持无论年龄大小,在开始抗逆转录病毒治疗之前和之后都要评估血脂谱。