在亚的斯亚贝巴的抗逆转录病毒初治的 HIV 感染成年人中，营养不良和脂类异常：一项横断面研究。
Malnutrition and lipid abnormalities in antiretroviral naïve HIV-infected adults in Addis Ababa: A cross-sectional study.
机构信息
Microbial, Cellular and Molecular Biology Department, Addis Ababa University, Addis Ababa, Ethiopia.
Armauer Hansen Research Institute, Addis Ababa, Ethiopia.
出版信息
PLoS One. 2018 Apr 19;13(4):e0195942. doi: 10.1371/journal.pone.0195942. eCollection 2018.
BACKGROUND
Both under- and over-nutrition may occur among human immunodeficiency virus (HIV)-infected individuals and impact on the course of the acquired immune deficiency syndrome (AIDS) and its management due to the close interaction between immunity and nutrition. We investigated occurrence of undernutrition, excess weight and lipid abnormalities among antiretroviral naïve HIV-infected adults in Addis Ababa, Ethiopia.
METHODS
A cross-sectional study on 594 antiretroviral therapy (ART) naïve HIV-infected adults was conducted in four hospitals in Addis Ababa from February to September 2013. Hematological parameters (CD4+ T cell count and hemoglobin concentration), fasting serum glucose, total cholesterol (TC) and triglycerides (TG) were determined. Information on socio-demographic, anthropometric and World Health Organization (WHO) clinical stages was collected from patient clinical records, and triangulated by structured questionnaire. Height and weight measurements were taken and body mass index (BMI), undernutrition (BMI <18.5 kg/m2) and excess weight (BMI ≥25 kg/m2) determined. Statistical comparisons were made to identify significant factors associated with nutritional status and lipid profiles.
RESULTS
The prevalence of undernutrition was 15.1%, and the prevalence of excess weight was 22.1%, including 5.4% who were obese. The prevalence of hypercholesterolemia was 16.6% and it was higher in women (18.9%) than in men (11.0%) (p<0.05). However, the prevalence of hypertriglyceridemia was 29.8%. There was significant positive Spearman correlation between CD4+ T cell count and serum TC (r = 0.210, p<0.001), but no correlation was observed between CD4+ T cell count and TG (r = -0.007, p>0.05). Age categories 30-39 and 40-79, and WHO clinical stages III/IV for undernutrition; age categories 30-39 and 40-79, WHO clinical stages III/IV and TC ≥200 mg/dL for excess weight; and being female, age categories 30-39 and 40-79, and hypertriglyceridemia for hypercholesterolemia were found to be independent predictors by binomial logistic regression analysis.
CONCLUSION
Undernutrition, excess weight, hypercholesterolemia and hypertriglyceridemia were variably prevalent in ART naïve HIV-infected populations. This emphasizes the need for targeted nutritional programs as an integral part of HIV/AIDS care. Lipid levels need to be monitored regularly in patients whether on or off ART. In addition, improvement on household income and positive change in lifestyle and/or nutritional treatment to reduce morbidity and mortality are necessary interventions in HIV/AIDs patient management.
背景
人类免疫缺陷病毒（HIV）感染者可能存在营养不足或营养过剩的情况，这会影响获得性免疫缺陷综合征（AIDS）的进程及其管理，因为免疫和营养之间存在密切的相互作用。我们调查了埃塞俄比亚亚的斯亚贝巴的 594 名接受抗逆转录病毒治疗（ART）的 HIV 感染者中发生的营养不良、超重和血脂异常情况。
方法
2013 年 2 月至 9 月，在亚的斯亚贝巴的四家医院对 594 名接受抗逆转录病毒治疗（ART）的 HIV 感染者进行了横断面研究。测定了血液学参数（CD4+ T 细胞计数和血红蛋白浓度）、空腹血糖、总胆固醇（TC）和甘油三酯（TG）。从患者临床记录中收集了社会人口统计学、人体测量学和世界卫生组织（WHO）临床分期信息，并通过结构化问卷进行了三角验证。测量了身高和体重，并确定了体重指数（BMI）、营养不良（BMI<18.5 kg/m2）和超重（BMI≥25 kg/m2）。进行了统计学比较，以确定与营养状况和血脂谱相关的显著因素。
结果
营养不良的患病率为 15.1%，超重的患病率为 22.1%，其中 5.4%为肥胖。高胆固醇血症的患病率为 16.6%，女性（18.9%）高于男性（11.0%）（p<0.05）。然而，高甘油三酯血症的患病率为 29.8%。CD4+ T 细胞计数与血清 TC 之间存在显著的正 Spearman 相关关系（r=0.210，p<0.001），但 CD4+ T 细胞计数与 TG 之间无相关性（r=-0.007，p>0.05）。营养不良的独立预测因素为年龄 30-39 岁和 40-79 岁以及 WHO 临床分期 III/IV 期；超重的独立预测因素为年龄 30-39 岁和 40-79 岁、WHO 临床分期 III/IV 期和 TC≥200 mg/dL；高胆固醇血症的独立预测因素为女性、年龄 30-39 岁和 40-79 岁以及高甘油三酯血症。
结论
在接受抗逆转录病毒治疗的 HIV 感染者中，营养不良、超重、高胆固醇血症和高甘油三酯血症的患病率各不相同。这强调了需要将有针对性的营养方案作为艾滋病护理的一个组成部分。无论患者是否接受 ART 治疗，都需要定期监测血脂水平。此外，改善家庭收入以及生活方式和/或营养治疗的积极改变，以降低发病率和死亡率，这是 HIV/AIDS 患者管理中的必要干预措施。
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