Malawi 开展的一项前瞻性队列研究：抗逆转录病毒治疗的 HIV 患者中心血管代谢危险因素对全因死亡率的影响。
Effect of cardio-metabolic risk factors on all-cause mortality among HIV patients on antiretroviral therapy in Malawi: A prospective cohort study.
机构信息
Dignitas International, Zomba, Malawi.
Pirimiti Rural Hospital, Pirimiti, Malawi.
出版信息
PLoS One. 2019 Jan 17;14(1):e0210629. doi: 10.1371/journal.pone.0210629. eCollection 2019.
BACKGROUND
Cardiovascular disease (CVD) risk among people living with HIV is elevated due to persistent inflammation, hypertension and diabetes comorbidity, lifestyle factors and exposure to antiretroviral therapy (ART). Data from Africa on how CVD risk affects morbidity and mortality among ART patients are lacking. We explored the effect of CVD risk factors and the Framingham Risk Score (FRS) on medium-term ART outcomes.
METHODS
A prospective cohort study of standardized ART outcomes (Dead, Alive on ART, stopped ART, Defaulted and Transferred out) was conducted from July 2014-December 2016 among patients on ART at a rural and an urban HIV clinic in Zomba district, Malawi. The primary outcome was Dead. Active defaulter tracing was not done and patients who transferred out and defaulted were excluded from the analysis. At enrolment, hypertension, diabetes and dyslipidemia were diagnosed, lifestyle data collected and the FRS was determined. Cox-regression analysis was used to determine independent risk factors for the outcome Dead.
RESULTS
Of 933 patients enrolled, median age was 42 years (IQR: 35-50), 72% were female, 24% had hypertension, 4% had diabetes and 15.8% had elevated total cholesterol. The median follow up time was 2.4 years. Twenty (2.1%) patients died, 50 (5.4%) defaulted, 63 (6.8%) transferred out and 800 (85.7%) were alive on ART care (81.7% urban vs. 89.9% rural). In multivariable survival analysis, male gender (aHR = 3.28; 95%CI: 1.33-8.07, p = 0.01) and total/HDL cholesterol ratio (aHR = 5.77, 95%CI: 1.21-27.32; p = 0.03) were significantly associated with mortality. There was no significant association between mortality and hypertension, body mass index, central obesity, diabetes, FRS, physical inactivity, smoking at enrolment, ART regimen and WHO disease stage.
CONCLUSIONS
Medium-term all-cause mortality among ART patients was associated with male gender and elevated total/HDL cholesterol ratio.
背景
由于持续的炎症、高血压和糖尿病合并症、生活方式因素以及抗逆转录病毒疗法 (ART) 的暴露，HIV 感染者的心血管疾病 (CVD) 风险升高。关于 CVD 风险如何影响 ART 患者的发病率和死亡率，非洲尚无相关数据。我们探讨了 CVD 危险因素和弗雷明汉风险评分 (FRS) 对中期 ART 结果的影响。
方法
对 2014 年 7 月至 2016 年 12 月期间在马拉维宗巴区农村和城市 HIV 诊所接受 ART 的患者进行了一项前瞻性队列研究，以评估标准化的 ART 结果（死亡、ART 存活、停止 ART、失访和转出）。主要结局为死亡。未进行主动失访追踪，转出和失访的患者被排除在分析之外。入组时诊断高血压、糖尿病和血脂异常，收集生活方式数据并确定 FRS。采用 Cox 回归分析确定结局死亡的独立危险因素。
结果
在纳入的 933 名患者中，中位年龄为 42 岁（IQR：35-50），72%为女性，24%患有高血压，4%患有糖尿病，15.8%总胆固醇升高。中位随访时间为 2.4 年。20 名（2.1%）患者死亡，50 名（5.4%）失访，63 名（6.8%）转出，800 名（85.7%）仍在接受 ART 治疗（城市 81.7%，农村 89.9%）。多变量生存分析显示，男性（aHR = 3.28；95%CI：1.33-8.07，p = 0.01）和总胆固醇/高密度脂蛋白胆固醇比值（aHR = 5.77，95%CI：1.21-27.32；p = 0.03）与死亡率显著相关。高血压、体重指数、中心性肥胖、糖尿病、FRS、体力活动不足、入组时吸烟、ART 方案和世卫组织疾病阶段与死亡率之间无显著相关性。
结论
ART 患者的中期全因死亡率与男性和总胆固醇/高密度脂蛋白胆固醇比值升高有关。
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