Faculty of medicine, Sorbonne université, inserm UMR_S938, ICAN, AP-HP, hôpital Tenon, 27, rue Chaligny, 75571 Paris cedex 12, Paris, France.
Université Paris Diderot, Sorbonne Paris Cité, inserm UMR_S1137, COREB APHP, 16, rue Henri-Huchard, 75890 Paris cedex 18, France.
Diabetes Metab. 2019 Dec;45(6):573-581. doi: 10.1016/j.diabet.2019.02.008. Epub 2019 Mar 9.
Ageing HIV-infected patients controlled by antiretroviral therapy (ART) frequently present age-related comorbidities, such as cardiovascular (CV) events, diabetes, dyslipidaemia, hypertension and chronic kidney disease (CKD). The prevalence of these comorbidities was evaluated in a cohort of long-term-monitored ART-controlled HIV-infected patients, then followed by a search into whether oxidative stress, like inflammation, might be associated with metabolic parameters and/or comorbidities.
Included were 352 long-term ART patients who started with protease inhibitors (PIs) in 1997-1999. They were evaluated at their final visit, 11 years later, for previous CV events, prevalence of diabetes, LDL-related and atherogenic (high TG/HDL) dyslipidaemias, hypertension and CKD. Also measured were circulating biomarkers to explore oxidative stress (Lp-PLA2, oxLDL, oxLDL/LDL ratio, paraoxonase and arylesterase activities), inflammation/immune activation (hsCRP, hsIL-6, D dimer, soluble CD14, β2 microglobulin, cystatin C), adipokines and insulin resistance. Levels were compared in patients with and without each comorbidity or condition using non-parametric correlation tests and multivariate adjusted analyses.
At the final visit, 81.5% of patients were male and were aged (median, IQR) 49 years (45-56); BMI was 23.0 kg/m (21.1-25.4), CD4+ lymphocytes were 620 cells/mm (453-790) and 91.5% had undetectable HIV-1 viral loads. The prevalence of diabetes was 11%, and LDL-related dyslipidaemia 28%, atherogenic dyslipidaemia 9%, hypertension 28%, CKD 9% and previous CV events 9%. Diabetes and atherogenic dyslipidaemia were associated with increased oxidative stress and independently with inflammation. LDL-related dyslipidaemia and impaired fasting glucose were associated with increased oxidative stress. No association of these biomarkers was detected with hypertension, CKD and previous CV events.
In long-term-treated HIV-infected patients with frequent comorbid conditions, oxidative stress could be contributing to diabetes and LDL-related and atherogenic dyslipidaemias independently of inflammation.
接受抗逆转录病毒疗法（ART）治疗的艾滋病毒感染老年患者常出现与年龄相关的合并症，如心血管（CV）事件、糖尿病、血脂异常、高血压和慢性肾脏病（CKD）。本研究评估了一组长期接受 ART 治疗并得到控制的 HIV 感染患者的这些合并症的患病率，然后研究了氧化应激（如炎症）是否与代谢参数和/或合并症相关。
纳入了 1997 年至 1999 年开始接受蛋白酶抑制剂（PI）治疗的 352 名长期接受 ART 治疗的患者。在 11 年后的最后一次就诊时，评估他们之前是否发生过 CV 事件、糖尿病、LDL 相关和致动脉粥样硬化（高 TG/HDL）血脂异常、高血压和 CKD。还测量了循环生物标志物以探索氧化应激（Lp-PLA2、氧化 LDL、氧化 LDL/LDL 比值、对氧磷酶和芳基酯酶活性）、炎症/免疫激活（hsCRP、hsIL-6、D 二聚体、可溶性 CD14、β2 微球蛋白、胱抑素 C）、脂肪因子和胰岛素抵抗。使用非参数相关检验和多变量调整分析比较了有和无每种合并症或疾病的患者之间的水平。
在最后一次就诊时，81.5%的患者为男性，年龄（中位数，IQR）为 49 岁（45-56）；BMI 为 23.0kg/m（21.1-25.4），CD4+淋巴细胞为 620 个细胞/mm（453-790），91.5%的患者 HIV-1 病毒载量无法检测。糖尿病的患病率为 11%，LDL 相关血脂异常为 28%，致动脉粥样硬化血脂异常为 9%，高血压为 28%，CKD 为 9%，之前的 CV 事件为 9%。糖尿病和致动脉粥样硬化血脂异常与氧化应激增加有关，并且与炎症独立相关。LDL 相关血脂异常和空腹血糖受损与氧化应激增加相关。这些生物标志物与高血压、CKD 和之前的 CV 事件无关联。
在经常出现合并症的长期接受治疗的 HIV 感染患者中，氧化应激可能独立于炎症导致糖尿病以及 LDL 相关和致动脉粥样硬化血脂异常。
