HIV感染者中危险饮酒、物质使用及吸烟与脂肪代谢障碍和脂肪萎缩之间的关联
Associations Between At-Risk Alcohol Use, Substance Use, and Smoking with Lipohypertrophy and Lipoatrophy Among Patients Living with HIV.
作者信息
Noorhasan Marisela, Drozd Daniel R, Grunfeld Carl, Merrill Joseph O, Burkholder Greer A, Mugavero Michael J, Willig James H, Willig Amanda L, Cropsey Karen L, Mayer Kenneth H, Blashill Aaron, Mimiaga Matthew, McCaul Mary E, Hutton Heidi, Chander Geetanjali, Mathews William C, Napravnik Sonia, Eron Joseph J, Christopoulos Katerina, Fredericksen Rob J, Nance Robin M, Delaney Joseph Chris, Crane Paul K, Saag Michael S, Kitahata Mari M, Crane Heidi M
机构信息
1 Department of Medicine, University of Washington , Seattle, Washington.
2 Department of Medicine, University of California at San Francisco , San Francisco, California.
出版信息
AIDS Res Hum Retroviruses. 2017 Jun;33(6):534-545. doi: 10.1089/AID.2015.0357. Epub 2017 Feb 16.
OBJECTIVE
To examine associations between lipohypertrophy and lipoatrophy and illicit drug use, smoking, and at-risk alcohol use among a large diverse cohort of persons living with HIV (PLWH) in clinical care.
METHODS
7,931 PLWH at six sites across the United States completed 21,279 clinical assessments, including lipohypertrophy and lipoatrophy, drug/alcohol use, physical activity level, and smoking. Lipohypertrophy and lipoatrophy were measured using the FRAM body morphology instrument and associations were assessed with generalized estimating equations.
RESULTS
Lipohypertrophy (33% mild, 4% moderate-to-severe) and lipoatrophy (20% mild, 3% moderate-to-severe) were common. Older age, male sex, and higher current CD4 count were associated with more severe lipohypertrophy (p values <.001-.03). Prior methamphetamine or marijuana use, and prior and current cocaine use, were associated with more severe lipohypertrophy (p values <.001-.009). Older age, detectable viral load, and low current CD4 cell counts were associated with more severe lipoatrophy (p values <.001-.003). In addition, current smoking and marijuana and opiate use were associated with more severe lipoatrophy (p values <.001-.03). Patients with very low physical activity levels had more severe lipohypertrophy and also more severe lipoatrophy than those with all other activity levels (p values <.001). For example, the lipohypertrophy score of those reporting high levels of physical activity was on average 1.6 points lower than those reporting very low levels of physical activity (-1.6, 95% CI: -1.8 to -1.4, p < .001).
CONCLUSIONS
We found a high prevalence of lipohypertrophy and lipoatrophy among a nationally distributed cohort of PLWH. While low levels of physical activity were associated with both lipohypertrophy and lipoatrophy, associations with substance use and other clinical characteristics differed between lipohypertrophy and lipoatrophy. These results support the conclusion that lipohypertrophy and lipoatrophy are distinct, and highlight differential associations with specific illicit drug use.
目的
在接受临床护理的一大群多样化的艾滋病毒感染者（PLWH）中，研究脂肪增生和脂肪萎缩与非法药物使用、吸烟及危险饮酒之间的关联。
方法
美国六个地点的7931名PLWH完成了21279次临床评估，包括脂肪增生和脂肪萎缩、药物/酒精使用、身体活动水平及吸烟情况。使用FRAM身体形态测量仪测量脂肪增生和脂肪萎缩，并通过广义估计方程评估关联。
结果
脂肪增生（33%为轻度，4%为中度至重度）和脂肪萎缩（20%为轻度，3%为中度至重度）很常见。年龄较大、男性及当前CD4计数较高与更严重的脂肪增生相关（p值<0.001 - 0.03）。既往使用甲基苯丙胺或大麻，以及既往和当前使用可卡因，与更严重的脂肪增生相关（p值<0.001 - 0.009）。年龄较大、可检测到病毒载量及当前CD4细胞计数较低与更严重的脂肪萎缩相关（p值<0.001 - 0.003）。此外，当前吸烟以及使用大麻和阿片类药物与更严重的脂肪萎缩相关（p值<0.001 - 0.03）。身体活动水平极低的患者比其他所有活动水平的患者有更严重的脂肪增生和更严重的脂肪萎缩（p值<0.001）。例如，报告身体活动水平高的患者的脂肪增生评分平均比报告身体活动水平极低的患者低1.6分（-1.6，95%置信区间：-1.8至-1.4，p < 0.001）。
结论
我们在全国分布的PLWH队列中发现脂肪增生和脂肪萎缩的患病率很高。虽然低水平的身体活动与脂肪增生和脂肪萎缩均相关，但脂肪增生和脂肪萎缩与物质使用及其他临床特征的关联有所不同。这些结果支持脂肪增生和脂肪萎缩是不同的这一结论，并突出了与特定非法药物使用的差异关联。
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