Nduka Chidozie U, Uthman Olalekan A, Kimani Peter K, Malu Abraham O, Stranges Saverio
Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
Infect Dis Poverty. 2016 Jun 1;5(1):55. doi: 10.1186/s40249-016-0152-7.
Previous studies of HIV-infected patients have shown significant associations between highly active antiretroviral therapy (HAART) and increased blood pressure; however, the mechanisms involved are less clear. Therefore, we sought to investigate the potential impact of body fat changes in mediating the effects of HAART on blood pressure changes among people living with HIV.
Four hundred six consenting patients (≥18 years of age) attending a tertiary HIV clinic in semi-urban Nigeria were recruited between August and November 2014 as part of a cross-sectional study. We performed bias-corrected bootstrap tests of mediation using 95 % confidence intervals (CI) to determine the mediating effects of body mass index and waist circumference (mediators) on the total effects of HAART exposure (primary predictor) on blood pressure (outcome), while controlling for age, sex and other potential confounders.
Waist circumference remained a significant partial mediator of the total effects of HAART exposure on increasing systolic blood pressure (coefficient: 1.01, 95 % CI: 0.33 to 2.52, 11 % mediated) and diastolic blood pressure (coefficient: 0.68, 95 % CI: 0.26 to 1.89, 9 % mediated) after adjusting for age, sex, smoking status, CD4 count and duration of HIV infection. No significant mediating effect was observed with body mass index alone or in combination with waist circumference after adjusting for all potential confounders.
Waist circumference significantly mediates the effects of HAART on blood pressure in persons living with HIV, independent of the role of traditional risk factors. The use of waist circumference as a complementary body fat measure to body mass index may improve the clinical prediction of hypertension in HIV-infected patients on antiretroviral therapy.
先前对HIV感染患者的研究表明，高效抗逆转录病毒疗法（HAART）与血压升高之间存在显著关联；然而，其中涉及的机制尚不清楚。因此，我们试图研究身体脂肪变化在介导HAART对HIV感染者血压变化影响方面的潜在作用。
2014年8月至11月，作为一项横断面研究的一部分，招募了406名同意参与的患者（年龄≥18岁），他们在尼日利亚半城市地区的一家三级HIV诊所就诊。我们使用95%置信区间（CI）进行偏差校正的中介引导检验，以确定体重指数和腰围（中介变量）对HAART暴露（主要预测因素）对血压（结果）的总效应的中介作用，同时控制年龄、性别和其他潜在混杂因素。
在调整年龄、性别、吸烟状况、CD4细胞计数和HIV感染持续时间后，腰围仍然是HAART暴露对收缩压升高总效应的显著部分中介变量（系数：1.01，95%CI：0.33至2.52，中介效应为11%）和舒张压升高总效应的显著部分中介变量（系数：0.68，95%CI：0.26至1.89，中介效应为9%）。在调整所有潜在混杂因素后，单独的体重指数或与腰围联合均未观察到显著的中介效应。
腰围显著介导了HAART对HIV感染者血压的影响，独立于传统危险因素的作用。将腰围作为体重指数的补充性身体脂肪测量指标，可能会改善接受抗逆转录病毒治疗的HIV感染患者高血压的临床预测。
