Labhardt Niklaus Daniel, Müller Urs Franz, Ringera Isaac, Ehmer Jochen, Motlatsi Mokete M, Pfeiffer Karolin, Hobbins Michael A, Muhairwe Josephine A, Muser Juergen, Hatz Christoph
Swiss Tropical and Public Health Institute, Basel, Switzerland.
University of Basel, Basel, Switzerland.
Trop Med Int Health. 2017 Jun;22(6):725-733. doi: 10.1111/tmi.12872. Epub 2017 May 4.
To assess the prevalence of metabolic syndrome (MetS) among patients in rural Lesotho who are taking first-line antiretroviral therapy (ART) containing either zidovudine or tenofovir disoproxil.
Cross-sectional survey in 10 facilities in Lesotho among adult (≥16 years) patients on non-nucleoside reverse transcriptase inhibitor (NNRTI)-based first-line ART for ≥6 months. MetS was defined according to the International Diabetes Federation criteria.
Among 1166 patients (65.8% female), 22.2% (95% CI: 19.3-25.3) of women and 6.3% (4.1-9.1) of men met the IDF definition of MetS (P < 0.001). In both sexes, there was no significant difference in MetS prevalence between NNRTIs. However, in women taking zidovudine as nucleoside reverse transcriptase inhibitor (NRTI), MetS prevalence was 27.9%, vs. 18.8% in those taking tenofovir. In the multivariate logistic regression allowing for socio-demographic and clinical covariates, ART containing zidovudine was associated with MetS in women (aOR 2.17 (1.46-3.22), P < 0.001) but not in men.
In this study, taking ART containing zidovudine instead of tenofovir disoproxil was an independent predictor of MetS in women but not in men. This finding endorses WHO's recommendation of tenofovir as preferred NRTI.
评估莱索托农村地区接受含齐多夫定或替诺福韦酯的一线抗逆转录病毒治疗（ART）的患者中代谢综合征（MetS）的患病率。
在莱索托的10个医疗机构对年龄≥16岁、接受基于非核苷类逆转录酶抑制剂（NNRTI）的一线ART治疗≥6个月的成年患者进行横断面调查。根据国际糖尿病联盟标准定义MetS。
在1166例患者中（65.8%为女性），22.2%（95%可信区间：19.3 - 25.3）的女性和6.3%（4.1 - 9.1）的男性符合IDF对MetS的定义（P < 0.001）。在男女两性中，不同NNRTIs之间的MetS患病率无显著差异。然而，在以齐多夫定作为核苷类逆转录酶抑制剂（NRTI）的女性中，MetS患病率为27.9%，而服用替诺福韦的女性为18.8%。在考虑社会人口统计学和临床协变量的多因素逻辑回归分析中，含齐多夫定的ART与女性的MetS相关（调整后比值比2.17（1.46 - 3.22），P < 0.001），但与男性无关。
在本研究中，使用含齐多夫定而非替诺福韦酯的ART是女性MetS的独立预测因素，但在男性中并非如此。这一发现支持了世界卫生组织推荐替诺福韦作为首选NRTI的建议。
