南非人类免疫缺陷病毒感染和未感染儿童队列的生长模式、身体成分和血脂谱：一项横断面研究。
Patterns of Growth, Body Composition, and Lipid Profiles in a South African Cohort of Human Immunodeficiency Virus-Infected and Uninfected Children: A Cross-Sectional Study.
机构信息
Gertrude H. Sergievsky Center, Columbia University, New York.
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York.
出版信息
J Pediatric Infect Dis Soc. 2018 May 15;7(2):143-150. doi: 10.1093/jpids/pix026.
BACKGROUND
Prior research in sub-Saharan Africa reports dyslipidemia in perinatally human immunodeficiency virus (HIV)-infected children receiving ritonavir-boosted lopinavir (LPV/r) compared with efavirenz; however, interpretation of findings is limited by lack of comparison data from HIV-uninfected children.
METHODS
We conducted a cross-sectional analysis of lipid profiles and growth within a larger longitudinal cohort study of perinatally HIV-infected and HIV-uninfected children aged 4-9 years in Johannesburg, South Africa. At enrollment, anthropometrics, viral load, CD4, total cholesterol (TC), high-density lipoprotein, low-density lipoprotein (LDL), and triglycerides were measured. Weight-for-age Z-score (WAZ), height-for-age Z-score (HAZ), and body mass index-for-age Z-score (BAZ) were calculated. United States pediatric thresholds for dyslipidemia were used.
RESULTS
Five hundred fifty-three HIV-infected and 300 HIV-uninfected children (median age 6.9 years) of similar demographic characteristics were enrolled. Of the HIV-infected children, 94.8% were on combination antiretroviral therapy (cART) (65.4% on LPV/r- and 28.6% on efavirenz-based regimens). Among the treated, 94.3% had a viral load <200 copies/mL. Median CD4% was 34.4. The HIV-infected children had lower mean WAZ (-0.7 vs -0.3, P < .01) and HAZ (-1.1 vs -0.7, P < .01) compared with HIV-uninfected children. A lower proportion of HIV-infected children were overweight (BAZ >1) compared with HIV-uninfected children (14.4% vs 21.7%, P = .04). Whether on LPV/r or efavirenz, a higher proportion of HIV-infected children had borderline/elevated TC or abnormal triglycerides than HIV-uninfected children, although a higher proportion of those on LPV/r had borderline/elevated TC, borderline/elevated LDL, or abnormal triglycerides than those on efavirenz.
CONCLUSIONS
In a South African cohort of HIV-infected children and population-appropriate HIV-uninfected children, unfavorable alterations in lipid profiles were detected in HIV-infected children regardless of treatment regimen compared with HIV-uninfected children. The HIV-infected children were of smaller size than HIV-uninfected children, but there was a high prevalence of overweight in both groups. Strategies for optimizing growth and early life management of lipid alterations may be warranted.
背景
先前在撒哈拉以南非洲的研究报告称，接受利托那韦增强洛匹那韦（LPV/r）治疗的围产期人类免疫缺陷病毒（HIV）感染儿童的血脂异常发生率高于依非韦伦，但由于缺乏来自未感染 HIV 的儿童的对照数据，因此对这些发现的解释受到限制。
方法
我们对约翰内斯堡的 HIV 感染和未感染儿童进行了一项横断面分析，这些儿童在更大的围产期 HIV 感染和未感染儿童纵向队列研究中年龄在 4-9 岁。在入组时，测量了人体测量学、病毒载量、CD4、总胆固醇（TC）、高密度脂蛋白、低密度脂蛋白（LDL）和甘油三酯。计算体重年龄 Z 评分（WAZ）、身高年龄 Z 评分（HAZ）和体重指数年龄 Z 评分（BAZ）。使用美国儿科血脂异常标准。
结果
共纳入了 553 名 HIV 感染和 300 名 HIV 未感染的儿童（中位年龄 6.9 岁），两组儿童具有相似的人口统计学特征。94.8%的 HIV 感染儿童接受了联合抗逆转录病毒治疗（cART）（65.4%接受 LPV/r 治疗，28.6%接受依非韦伦治疗）。在接受治疗的儿童中，94.3%的病毒载量<200 拷贝/ml。中位 CD4%为 34.4。与 HIV 未感染儿童相比，HIV 感染儿童的平均 WAZ（-0.7 与-0.3，P<0.01）和 HAZ（-1.1 与-0.7，P<0.01）较低。与 HIV 未感染儿童相比，HIV 感染儿童中超重（BAZ>1）的比例较低（14.4%比 21.7%，P=0.04）。无论是接受 LPV/r 还是依非韦伦治疗，HIV 感染儿童的 TC 或甘油三酯异常的边缘/升高比例均高于 HIV 未感染儿童，但 LPV/r 治疗组 TC 边缘/升高、LDL 边缘/升高或甘油三酯异常的比例高于依非韦伦治疗组。
结论
在南非的 HIV 感染儿童队列和人群适当的 HIV 未感染儿童中，与 HIV 未感染儿童相比，无论治疗方案如何，HIV 感染儿童的脂质谱都发生了不利变化。与 HIV 未感染儿童相比，HIV 感染儿童的体型较小，但两组儿童的超重比例都很高。可能需要优化生长和早期生活脂质改变的管理策略。
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