Bhagwat Priya, Ofotokun Ighovwerha, McComsey Grace A, Brown Todd T, Moser Carlee, Sugar Catherine A, Currier Judith S
University of California, Los Angeles, Los Angeles, California.
Emory University School of Medicine, Department of Medicine, Atlanta, Georgia.
Open Forum Infect Dis. 2018 Nov 16;5(11):ofy201. doi: 10.1093/ofid/ofy201. eCollection 2018 Nov.
This study investigates the association of clinical and demographic predictors with abdominal fat gain, measured using waist circumference (WC) and self-reported abdominal size.
We analyzed data from ACTG A5257, a clinical trial that randomized treatment-naïve HIV-infected participants to 1 of 3 antiretroviral regimens: raltegravir (RAL) or the protease inhibitors (PIs) atazanavir/ritonavir (ATV/r) or darunavir/ritonavir (DRV/r), each in combination with tenofovir disoproxil fumarate/emtricitabine. Associations of treatment and baseline/demographic characteristics with 96-week WC change were assessed using repeated-measures models. Ordinal logistic regression was used to examine the associations of predictors with week 96 self-reported abdominal changes.
The study population (n = 1809) was 76.0% male and predominantly black non-Hispanic (41.9%) and white non-Hispanic (34.1%). Mean baseline WC was 90.6 cm, with an average 96-week increase of 3.4 cm. WC increases were higher in the RAL arm compared with DRV/r ( = .0130). Females experienced greater increases in WC on RAL vs ATV/r than males ( = .0065). Similarly, a larger difference in WC change was found for RAL vs DRV/r for black vs nonblack individuals ( = .0043). A separate multivariable model found that in addition to the treatment regimen, higher baseline viral load and lower CD4+ were also associated with WC increases.
With antiretroviral therapy initiation, higher WC increases in the RAL arm compared with PIs were more pronounced in female and black participants, and a more advanced baseline HIV disease state was a strong predictor of larger abdominal increases. Understanding factors predisposing individuals to abdominal fat gain could inform health management after therapy initiation.
本研究调查了临床和人口统计学预测因素与腹部脂肪增加之间的关联，腹部脂肪增加通过腰围（WC）和自我报告的腹部尺寸来衡量。
我们分析了ACTG A5257的数据，这是一项临床试验，将未接受过治疗的HIV感染参与者随机分配到三种抗逆转录病毒方案之一：拉替拉韦（RAL）或蛋白酶抑制剂阿扎那韦/利托那韦（ATV/r）或达芦那韦/利托那韦（DRV/r），每种方案均与富马酸替诺福韦二吡呋酯/恩曲他滨联合使用。使用重复测量模型评估治疗及基线/人口统计学特征与96周WC变化之间的关联。采用有序逻辑回归分析预测因素与96周自我报告的腹部变化之间的关联。
研究人群（n = 1809）中男性占76.0%，主要为非西班牙裔黑人（41.9%）和非西班牙裔白人（34.1%）。平均基线WC为90.6 cm，96周平均增加3.4 cm。与DRV/r组相比，RAL组的WC增加幅度更高（P = 0.0130）。女性在接受RAL治疗时WC的增加幅度大于男性接受ATV/r治疗时的增加幅度（P = 0.0065）。同样，黑人与非黑人个体在接受RAL治疗与DRV/r治疗时WC变化的差异更大（P = 0.0043）。另一个多变量模型发现，除治疗方案外，较高的基线病毒载量和较低的CD4+水平也与WC增加有关。
开始抗逆转录病毒治疗后，与蛋白酶抑制剂相比，RAL组WC增加幅度更高，在女性和黑人参与者中更为明显，基线HIV疾病状态越严重，腹部增加幅度越大的预测性越强。了解个体腹部脂肪增加的易感因素可为治疗开始后的健康管理提供参考。
