Santiprabhob Jeerunda, Tanchaweng Surapong, Maturapat Sirinoot, Maleesatharn Alan, Lermankul Watcharee, Sricharoenchai Sirintip, Wittawatmongkol Orasri, Lapphra Keswadee, Phongsamart Wanatpreeya, Chokephaibulkit Kulkanya
Division of Endocrinology and Metabolism, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Biomed Res Int. 2017;2017:7481597. doi: 10.1155/2017/7481597. Epub 2017 Feb 15.
Protease inhibitor (PI) may cause abnormal glucose metabolism, abnormal lipid metabolism, and metabolic syndrome in HIV-infected adults but less well studied in Asian adolescents. This cross-sectional study evaluated anthropometric factors, oral glucose tolerance test, and lipid profiles of perinatally HIV-infected Thai adolescents who had received PI-based antiretroviral therapy for at least 6 months. Eighty adolescents were enrolled [median (IQR) age 16.7 (14.6-18.0) years, 42 males]. Metabolic syndrome, prediabetes, and type 2 diabetes mellitus (T2DM) were found in 8 (10%), 17 (22.1%), and 3 (3.8%) adolescents, respectively. Dyslipidemia was found in 56 (70%) adolescents, with hypertriglyceridemia being the most common type. In multivariate analysis, presence of lipohypertrophy (OR: 25.7, 95% CI: 3.2-202.8; = 0.002) and longer duration of PI use (OR: 1.04, 95% CI: 1.00-1.08; = 0.023) were associated with metabolic syndrome. Obesity (OR: 7.71, 95% CI: 1.36-43.7; = 0.021), presence of lipohypertrophy (OR: 62.9, 95% CI: 4.97-795.6; = 0.001), and exposure to stavudine for ≥6 months (OR: 8.18, 95% CI: 1.37-48.7; = 0.021) were associated with prediabetes/T2DM, while exposure to tenofovir for ≥6 months reduced the risk (OR: 0.17, 95% CI: 0.04-0.78; = 0.022). Metabolic disorders were commonly found in adolescents receiving PI. Careful monitoring and early intervention to modify cardiovascular risk should be systematically implemented in this population particularly those with exposure to stavudine.
蛋白酶抑制剂（PI）可能会导致感染人类免疫缺陷病毒（HIV）的成年人出现异常的葡萄糖代谢、脂质代谢及代谢综合征，但在亚洲青少年中的相关研究较少。这项横断面研究评估了接受基于PI的抗逆转录病毒治疗至少6个月的泰国围产期感染HIV青少年的人体测量因素、口服葡萄糖耐量试验及血脂情况。共纳入80名青少年[年龄中位数（四分位间距）为16.7（14.6 - 18.0）岁，男性42名]。分别有8名（10%）、17名（22.1%）和3名（3.8%）青少年被发现患有代谢综合征、糖尿病前期和2型糖尿病（T2DM）。56名（70%）青少年存在血脂异常，其中高甘油三酯血症最为常见。多因素分析显示，脂肪增生的存在（比值比：25.7，95%置信区间：3.2 - 202.8；P = 0.002）和PI使用时间较长（比值比：1.04，95%置信区间：1.00 - 1.08；P = 0.023）与代谢综合征相关。肥胖（比值比：7.71，95%置信区间：1.36 - 43.7；P = 0.021）、脂肪增生的存在（比值比：62.9，95%置信区间：4.97 - 795.6；P = 0.001）以及接受司他夫定治疗≥6个月（比值比：8.18，95%置信区间：1.37 - 48.7；P = 0.021）与糖尿病前期/T2DM相关，而接受替诺福韦治疗≥6个月可降低风险（比值比：0.17，95%置信区间：0.04 - 0.78；P = 0.022）。接受PI治疗的青少年中代谢紊乱很常见。对于这一人群，尤其是那些接受过司他夫定治疗的人群，应系统地实施仔细监测和早期干预以改善心血管风险。
