体重指数对中国接受高效抗逆转录病毒治疗的 HIV 感染者免疫重建的预测作用。
Predictive effects of body mass index on immune reconstitution among HIV-infected HAART users in China.
机构信息
NHC Key Laboratory of AIDS Immunology (China Medical University), Department of Laboratory Medicine, The First Affiliated Hospital of China Medical University, No 155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, China.
Key Laboratory of AIDS Immunology of Liaoning Province, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China.
出版信息
BMC Infect Dis. 2019 May 2;19(1):373. doi: 10.1186/s12879-019-3991-6.
BACKGROUND
Body mass index (BMI) may contribute somewhat to drug metabolism, and thus affecting the efficacy of highly active antiretroviral therapy (HAART). This study aimed to determine the frequencies of underweight, normal and overweight/obesity at pre-HAART in a large cohort of HIV-infected Chinese patients, and investigate the prospective effects of BMI on immune reconstitution after HAART initiation.
METHODS
A longitudinal cohort study was performed to analyze the effects of BMI on immune reconstitution in HIV-infected patients treated with HAART. Multiple linear regression was used to evaluate the relationship between baseline BMI and increased CD4+ T lymphocyte levels at 12 and 30 months after initiating HAART. In addition, Cox proportional hazard model was used to assess the relationship between BMI and time to achieve immunologic reconstitution (CD4+ T lymphocytes>500cells/μL) during the follow-up period.
RESULTS
Among the 1612 enrolled patients, 283 (17.6%) were overweight/obese (BMI ≥ 25 kg/m), 173 (10.7%) were underweight (BMI < 18.5 kg/m) and the remaining were normal weight. Prior to HAART initiating, overweight HIV-infected patients were mostly males, older ages, exhibited higher CD4+ T lymphocytes and lower viral loads (p < 0.01 for all). Patients with higher baseline BMI had an independently positive effect on 30-month CD4+ T lymphocyte recovery (p = 0.028), but not 12-month CD4+ T lymphocyte gain (p = 0.104). In addition, a Cox proportional hazard model with baseline BMI as an independent variable indicated that BMI was correlated with an increased likelihood of achieving immunologic reconstitution over time (hazard ratios [HR] 1.03; 95% confidence intervals [CI] 1.01-1.06; p = 0.011), after adjusting for baseline age, gender, CD4+ T lymphocytes, CD4/CD8 ratio, viral load and WHO stage.
CONCLUSIONS
Higher baseline BMI could predict better immune reconstitution in HIV-infected patients after HAART initiating.
背景
体重指数（BMI）可能会对药物代谢产生一定影响，从而影响高效抗逆转录病毒治疗（HAART）的疗效。本研究旨在确定大量中国 HIV 感染患者在接受 HAART 前处于体重不足、正常和超重/肥胖的频率，并探讨 BMI 对 HAART 起始后免疫重建的前瞻性影响。
方法
进行了一项纵向队列研究，以分析 BMI 对接受 HAART 治疗的 HIV 感染患者免疫重建的影响。使用多元线性回归评估 HAART 起始后 12 个月和 30 个月时基线 BMI 与 CD4+T 淋巴细胞水平升高之间的关系。此外，使用 Cox 比例风险模型评估 BMI 与随访期间达到免疫重建（CD4+T 淋巴细胞>500 个/μL）的时间之间的关系。
结果
在纳入的 1612 名患者中，283 名（17.6%）超重/肥胖（BMI≥25kg/m），173 名（10.7%）体重不足（BMI<18.5kg/m），其余为正常体重。在开始 HAART 之前，超重的 HIV 感染患者主要为男性，年龄较大，表现出较高的 CD4+T 淋巴细胞和较低的病毒载量（p<0.01）。基线时较高的 BMI 对 30 个月时 CD4+T 淋巴细胞的恢复有独立的正向影响（p=0.028），但对 12 个月时 CD4+T 淋巴细胞的增加没有影响（p=0.104）。此外，以基线 BMI 为自变量的 Cox 比例风险模型表明，BMI 与随着时间的推移实现免疫重建的可能性增加相关（风险比[HR]1.03；95%置信区间[CI]1.01-1.06；p=0.011），调整了基线年龄、性别、CD4+T 淋巴细胞、CD4/CD8 比值、病毒载量和世界卫生组织（WHO）分期。
结论
较高的基线 BMI 可以预测 HIV 感染患者接受 HAART 后更好的免疫重建。
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