Nduka Chidozie U, Uthman Olalekan A, Kimani Peter K, Stranges Saverio
Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom.
Warwick-Centre for Applied Health Research and Delivery (WCAHRD). Warwick Medical School, University of Warwick, Coventry, United Kingdom; Department of Public Health (IHCAR), Karolinska Institute, Stockholm, Sweden; Centre for Evidence-Based Health Care, Stellenbosch University, Tygerberg, South Africa.
AIDS Rev. 2016 Oct-Dec;18(4):198-211.
Although more than one in two HIV-infected persons may develop central fat accumulation soon after commencing antiretroviral therapy, the association between antiretroviral therapy and body fat changes has not been consistent across primary epidemiological studies. We conducted a systematic review with meta-analyses to estimate the pooled effects of antiretroviral therapy on different measures of body fat, and to examine factors that potentially modify these effects. We searched for studies that compared body mass index, waist circumference, combined overweight/obesity, and central obesity between HIV-infected adults naive and exposed to antiretroviral therapy. Random-effects subgroup and meta-regression analyses were performed to identify potential effect-modifiers of the pooled associations. Sixty studies, comprising data on 53,199 HIV-infected participants, were eligible for the meta-analyses. Antiretroviral therapy was associated with increased body mass index (SMD: 0.17 kg/m2; 95% CI: 0.07-0.26), waist circumference (SMD: 0.20 cm; 95% CI: 0.07-0.33), overweight/obesity (borderline significance: OR: 1.36; 95% CI: 0.99-1.86), and abdominal obesity (OR: 1.49; 95% CI: 1.16-1.90). In addition, antiretroviral therapy was associated with significant increases in body mass index, overweight/obesity, and central obesity among patients with CD4 counts < 350 cells/mm3, but not among patients with higher CD4 counts (Pinteraction < 0.05 for all). Overall, exposure to antiretroviral therapy was associated with increased risks of generalized and central obesity, and risks may be exacerbated by lower CD4 counts. These findings suggest that weight management and obesity prevention programs may be worth considering as part of routine HIV care.
虽然超过二分之一的艾滋病毒感染者在开始抗逆转录病毒治疗后不久可能会出现中心性脂肪堆积，但在主要的流行病学研究中，抗逆转录病毒治疗与身体脂肪变化之间的关联并不一致。我们进行了一项系统评价和荟萃分析，以估计抗逆转录病毒治疗对不同身体脂肪测量指标的综合影响，并研究可能改变这些影响的因素。我们检索了比较未接受过抗逆转录病毒治疗的艾滋病毒感染成人和接受过抗逆转录病毒治疗的成人之间体重指数、腰围、超重/肥胖合并症以及中心性肥胖的研究。进行随机效应亚组分析和荟萃回归分析，以确定综合关联的潜在效应修饰因素。60项研究（包含53199名艾滋病毒感染参与者的数据）符合荟萃分析的条件。抗逆转录病毒治疗与体重指数增加（标准化均数差：0.17kg/m²；95%置信区间：0.07 - 0.26）、腰围增加（标准化均数差：0.20cm；95%置信区间：0.07 - 0.33）、超重/肥胖（临界显著性：比值比：1.36；95%置信区间：0.99 - 1.86）以及腹型肥胖（比值比：1.49；95%置信区间：1.16 - 1.90）相关。此外，抗逆转录病毒治疗与CD4细胞计数<350个细胞/mm³的患者体重指数、超重/肥胖及中心性肥胖显著增加相关，但在CD4细胞计数较高的患者中并非如此（所有P交互作用<0.05）。总体而言，接受抗逆转录病毒治疗与全身性肥胖和中心性肥胖风险增加相关，且较低的CD4细胞计数可能会加剧这些风险。这些发现表明，体重管理和肥胖预防计划作为常规艾滋病毒护理的一部分可能值得考虑。
