Faculty of Medicine, University of Porto. Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
Infectious Diseases Department, Centro Hospitalar São João, Porto, Portugal.
BMC Infect Dis. 2018 Jan 11;18(1):32. doi: 10.1186/s12879-017-2884-9.
Combined antiretroviral therapy (cART) in HIV-infected patients has been associated with lipodystrophy, metabolic abnormalities, and an increased risk of cardiovascular disease. Ultrasound measures of carotid artery intima-media thickness (cIMT) have been used as a valid measure of subclinical atherosclerosis and as a tool to predict the risk of cardiovascular events. Our aim was to evaluate the progression of cIMT in HIV-infected patients subjected to cART, with and without lipodystrophy, over a one-year period.
We performed a one-year prospective cohort study to compare changes in cIMT, metabolic and inflammation markers in HIV-infected patients undergoing cART. Body composition was assessed by dual-energy X-ray absorptiometry (DXA) and abdominal computed tomography (CT). Levels of blood pressure, lipids and inflammatory markers were evaluated, as well as ultrasound measures of cIMT. Lipodystrophy defined by Fat Mass Ratio (L-FMR) is measured as the ratio of the percentage of trunk fat mass to the percentage of lower limb fat mass by DXA. Categorical variables were compared, using the chi-square or Fisher's exact test. Wilcoxon ranks tests and the McNemar chi-square tests were used to compare results of selected variables, from the first to the second year of evaluation. Means of cIMT, adjusted for age, glucose, triglycerides levels, systolic blood pressure (SBP), and waist to hip ratio were calculated, using generalised linear models for repeated measures.
L-FMR was present in 44.3% of patients, and the mean of cIMT increased significantly in this group [0.82 (0.26) vs 0.92 (0.33); p = 0.037], as well as in patients without lipodystrophy [0.73 (0.20) vs 0.84 (0.30); p = 0.012]. In the overall sample, the progression of cIMT was statistically significant after the adjustment for age, glucose, triglycerides, and SBP, but the significance of the progression ceased after the adjustment for waist/hip ratio [0.770 (0.737-0.803) vs 0.874 (0.815-0.933); p = 0.514].
Carotid IMT progressed significantly in both groups of this HIV-infected cohort, however no association between the progression of cIMT and the presence of lipodystrophy defined by FMR was found. Visceral adipose tissue had an impact on the increment of cIMT, both in patients with, and without lipodystrophy defined by FMR.
在感染 HIV 的患者中，联合抗逆转录病毒疗法（cART）与脂肪代谢异常、代谢异常和心血管疾病风险增加有关。颈动脉内膜中层厚度（cIMT）的超声测量已被用作亚临床动脉粥样硬化的有效测量指标，并作为预测心血管事件风险的工具。我们的目的是评估在接受 cART 的 HIV 感染患者中，有无脂肪代谢障碍，在一年的时间内 cIMT 的进展情况。
我们进行了一项为期一年的前瞻性队列研究，比较了接受 cART 的 HIV 感染患者 cIMT、代谢和炎症标志物的变化。通过双能 X 线吸收法（DXA）和腹部 CT 评估身体成分。评估血压、血脂和炎症标志物水平，以及 cIMT 的超声测量。脂肪质量比（L-FMR）定义的脂肪代谢障碍是通过 DXA 测量的躯干脂肪质量百分比与下肢脂肪质量百分比的比值。分类变量比较采用卡方检验或 Fisher 确切概率法。Wilcoxon 秩和检验和 McNemar 卡方检验用于比较第二年评估时选定变量的结果。使用广义线性重复测量模型计算年龄、血糖、甘油三酯水平、收缩压（SBP）和腰臀比校正后的 cIMT 均值。
L-FMR 存在于 44.3%的患者中，该组的 cIMT 平均值显著增加[0.82（0.26）与 0.92（0.33）；p=0.037]，无脂肪代谢障碍的患者也如此[0.73（0.20）与 0.84（0.30）；p=0.012]。在总体样本中，cIMT 的进展在调整年龄、血糖、甘油三酯和 SBP 后具有统计学意义，但在调整腰围/臀围比后，进展的意义消失[0.770（0.737-0.803）与 0.874（0.815-0.933）；p=0.514]。
在这个 HIV 感染队列的两组中，颈动脉 IMT 均显著进展，但未发现 cIMT 进展与 FMR 定义的脂肪代谢障碍之间存在关联。内脏脂肪组织对 FMR 定义的有或无脂肪代谢障碍的患者的 cIMT 增加均有影响。
