Department of Endocrinology, Diabetology & Metabolic Disorders, Venkateshwar Hospitals; Department of Endocrinology, Post Graduate Institute of Medical Education & Research & Dr. Ram Manohar Lohia Hospital, New Delhi, India.
Department of Rheumatology, Venkateshwar Hospitals, New Delhi, India.
Indian J Med Res. 2018 Oct;148(4):411-421. doi: 10.4103/ijmr.IJMR_236_17.
BACKGROUND & OBJECTIVES: Dyslipidaemia is a major contributor to cardiovascular morbidity, which is increased in HIV. Data on dyslipidaemia in Indians with HIV are scant. This study was undertaken to determine the predictors of dyslipidaemia and lipoatrophy in Indians with HIV infection and their relation with body composition parameters.
A total of 382 consecutive patients with HIV infection were screened, of whom 257 clinically stable patients, without any acute comorbidity, having at least one year follow up underwent biochemical and DEXA analysis.
The most common dyslipidaemia was hypertriglyceridaemia (47.08%), followed by hypercholesterolaemia [total cholesterol (TC)] (38.91%) and low high-density lipoprotein (HDL) cholesterol (38.52%), in patients having median age 37 (32-42) yr and HIV duration 57 (33-101) months. Patients with at least one dyslipidaemia (78.99%) had significantly higher insulin resistance (IR), per cent body fat, per cent trunk fat (PTF) and trunk limb fat ratio (TLFR). Baseline CD4 count and delta CD4 count (change in CD4 count 6-12 months following ART) had significant inverse correlation with triglycerides and TC. Patients with highest triglycerides and cholesterol quartiles had significantly higher immune reconstitution, metabolic syndrome, IR, trunk fat mass (FM), PTF and TLFR, with comparable total FM. Logistic regression revealed that body mass index, HIV duration and PTF were independent predictors of hypertriglyceridaemia, with only PTF being significant predictor of hypercholesterolaemia. Every unit increase in PTF was associated with 13 and 4.1 per cent increased hypertriglyceridaemia and hypercholesterolaemia. Lipoatrophy was present in 8.57 per cent patients and was a poor predictor of dyslipidaemia.
INTERPRETATION & CONCLUSIONS: : High occurrence of dyslipidaemia was observed in patients with HIV on anti retroviral therapy. Central adiposity (TFM) was the most important predictor of dyslipidaemia in these patients.
血脂异常是心血管疾病发病率增加的主要原因，而 HIV 感染者的心血管疾病发病率更高。目前有关 HIV 感染者血脂异常的数据较少。本研究旨在确定 HIV 感染者血脂异常和脂肪减少的预测因素，并探讨其与身体成分参数的关系。
对 382 例连续 HIV 感染者进行筛查，其中 257 例临床稳定的患者，无任何急性并发症，随访时间至少 1 年，进行生化和 DEXA 分析。
最常见的血脂异常是高甘油三酯血症（47.08%），其次是高胆固醇血症（TC）（38.91%）和低高密度脂蛋白（HDL）胆固醇（38.52%），患者的中位年龄为 37（32-42）岁，HIV 持续时间为 57（33-101）个月。至少有一种血脂异常的患者（78.99%）的胰岛素抵抗（IR）、体脂肪百分比、躯干脂肪百分比（PTF）和躯干肢体脂肪比例（TLFR）显著更高。基线 CD4 计数和 delta CD4 计数（ART 后 6-12 个月 CD4 计数的变化）与甘油三酯和 TC 呈显著负相关。甘油三酯和胆固醇四分位数最高的患者具有显著更高的免疫重建、代谢综合征、IR、躯干脂肪量（FM）、PTF 和 TLFR，且总 FM 相当。逻辑回归显示，体重指数、HIV 持续时间和 PTF 是高甘油三酯血症的独立预测因素，只有 PTF 是高胆固醇血症的独立预测因素。PTF 每增加 1 个单位，患高甘油三酯血症和高胆固醇血症的风险分别增加 13%和 4.1%。脂肪减少症在 8.57%的患者中存在，但对血脂异常的预测价值较低。
接受抗逆转录病毒治疗的 HIV 患者血脂异常发生率较高。中心性肥胖（TFM）是这些患者血脂异常的最重要预测因素。
