Erlandson Kristine M, Fiorillo Suzanne, Masawi Fadzai, Scherzinger Ann, McComsey Grace A, Lake Jordan E, Stein James H, Currier Judith S, Brown Todd T
aUniversity of Colorado Anschutz Medical Campus, Aurora, Colorado bCase Western University, Cleveland, Ohio cUniversity of Texas Health Sciences Center, Houston, Texas dUniversity of Wisconsin School of Medicine and Public Health, Madison, Wisconsin eUniversity of California, Los Angeles, California fJohns Hopkins University, Baltimore, Maryland, USA.
AIDS. 2017 Aug 24;31(13):1831-1838. doi: 10.1097/QAD.0000000000001558.
A greater burden of physical function impairment occurs in HIV-infected adults; the impact of antiretroviral therapy (ART) initiation on muscle density (less dense = more fat), a measure of muscle quality, is unknown.
AIDS Clinical Trials Group Study A5260s, a cardiometabolic substudy of A5257, randomized HIV-infected, ART-naive adults to ritonavir-boosted atazanavir, darunavir, or raltegravir with tenofovir/emtricitabine backbone. Single-slice abdominal computed tomography scans from baseline and week 96 were reanalyzed for total and lean muscle area and density.
Two-sample t-tests described the differences between baseline and week 96 variables. Linear regression analysis was used to explore the role of a priori identified variables and potential confounders.
Participants (n = 235) were mostly men (90%); 31% were Black non-Hispanic; 21% were Hispanic. Over 96 weeks, small but significant increases were seen in oblique/transverse abdominal, rectus, and psoas muscle total area (range 0.21-0.83 cm; P < 0.05) but not the lean muscle component (all P ≥ 0.33). Significant decreases in overall density, consistent with increases in fat, were seen in all muscle groups (range -0.87 to -2.4 HU; P < 0.01); for the lean muscle component, only decreases in oblique/transverse abdominal and rectus reached statistical significance (P < 0.05). In multivariable analyses, Black race was associated with increased muscle density and female sex with decreased density; treatment arm was not associated with changes in mass or density.
The ART-associated increase in muscle area, regardless of regimen, is likely a reflection of increased fat within the muscle. The consequences of fatty infiltration of muscle on subsequent muscle function require further investigation.
HIV 感染的成年人身体功能损害负担更重；抗逆转录病毒疗法（ART）启动对肌肉密度（密度越低 = 脂肪越多）的影响尚不清楚，肌肉密度是衡量肌肉质量的一个指标。
艾滋病临床试验组研究 A5260s，A5257 的心脏代谢子研究，将未接受过 ART 的 HIV 感染成年人随机分为接受利托那韦增强的阿扎那韦、达芦那韦或拉替拉韦联合替诺福韦/恩曲他滨治疗。对基线和第 96 周的单层腹部计算机断层扫描进行重新分析，以测量总肌肉面积、瘦肌肉面积和密度。
两样本 t 检验描述了基线和第 96 周变量之间的差异。线性回归分析用于探讨预先确定的变量和潜在混杂因素的作用。
参与者（n = 235）大多为男性（90%）；31% 为非西班牙裔黑人；21% 为西班牙裔。在 96 周的时间里，腹斜肌/腹横肌、腹直肌和腰大肌的总肌肉面积有小幅但显著的增加（范围为 0.21 - 0.83 cm；P < 0.05），但瘦肌肉部分没有增加（所有 P ≥ 0.33）。所有肌肉组的总体密度均显著降低，这与脂肪增加一致（范围为 -0.87 至 -2.4 HU；P < 0.01）；对于瘦肌肉部分，只有腹斜肌/腹横肌和腹直肌的密度降低达到统计学意义（P < 0.05）。在多变量分析中，黑人种族与肌肉密度增加相关，女性与密度降低相关；治疗组与肌肉质量或密度的变化无关。
无论采用何种治疗方案，ART 相关的肌肉面积增加可能反映了肌肉内脂肪的增加。肌肉脂肪浸润对后续肌肉功能的影响需要进一步研究。
