Debroy Paula, Lake Jordan E, Sim Myung, Erlandson Kristine M, Falutz Julian, Prado Carla M, Brown Todd T, Guaraldi Giovanni, Metabolic Cohort Team The Modena Hiv
Division of Infectious Diseases, University of Texas Health Sciences Center, Houston, TX, USA.
Division of Infectious Diseases, University of California Los Angeles, Los Angeles, CA, USA.
Antivir Ther. 2019;24(5):383-387. doi: 10.3851/IMP3312.
The long-term trajectory of and factors affecting lean mass in people living with HIV (PLWH) are incompletely described.
PLWH in the Modena HIV Metabolic Cohort underwent dual-energy X-ray absorptiometry (DXA) scans every 6-12 months for up to 10 years (median 4.6 scans). Mixed effect regression modelling in combined and sex-stratified models determined annual rates of and clinical factors significantly associated with appendicular lean mass (ALM).
A total of 839 women and 1,759 men contributing ≥2 DXA scans had baseline median age 44 years and 14 years since HIV diagnosis; 76% were virologically suppressed on antiretroviral therapy (ART). Baseline median ALM was 16.9 kg for women and 24.8 kg for men. ALM decreased during the study period, with mean yearly ALM loss of -231 g in women and -322 g in men. Less ALM was associated with female sex, age >50 years, detectable HIV-1 RNA, and tenofovir and integrase inhibitor use. Greater ALM was associated with longer ART duration. In sex-stratified models, relationships between ALM and total ART duration and integrase inhibitor use were not significant for women, but the relationship with tenofovir use persisted. For men, AIDS wasting and CD4 T-lymphocyte nadir <200 cells/μl were independently associated with lower ALM.
ALM steadily declined over time in this cohort of PLWH on ART that included a large number of women. HIV- and ART-specific risk factors emerged that varied by sex. The observed associations between tenofovir or integrase inhibitor use and lower ALM particularly warrant further study.
感染HIV者（PLWH）瘦体重的长期变化轨迹及影响因素尚未完全明确。
摩德纳HIV代谢队列中的PLWH每6 - 12个月接受一次双能X线吸收测定（DXA）扫描，持续长达10年（中位扫描4.6次）。在合并模型和按性别分层的模型中进行混合效应回归建模，以确定与四肢瘦体重（ALM）显著相关的年变化率和临床因素。
共有839名女性和1759名男性进行了≥2次DXA扫描，基线时的中位年龄为44岁，自HIV诊断以来为14年；76%的患者接受抗逆转录病毒治疗（ART）后病毒得到抑制。女性基线时ALM的中位数为16.9 kg，男性为24.8 kg。在研究期间，ALM有所下降，女性平均每年ALM损失 - 231 g，男性为 - 322 g。较低的ALM与女性性别、年龄>50岁、可检测到的HIV - 1 RNA以及使用替诺福韦和整合酶抑制剂有关。较高的ALM与较长的ART疗程有关。在按性别分层的模型中，ALM与ART总疗程和整合酶抑制剂使用之间的关系在女性中不显著，但与替诺福韦使用的关系仍然存在。对于男性，艾滋病消瘦和CD4 T淋巴细胞最低点<200个细胞/μl与较低的ALM独立相关。
在这个接受ART治疗的PLWH队列中，包括大量女性，ALM随时间稳步下降。出现了特定于HIV和ART的危险因素，且因性别而异。观察到的替诺福韦或整合酶抑制剂使用与较低ALM之间的关联尤其值得进一步研究。
