Galdamez Ronald, García José A, Fernández Marta, Robledano Catalina, Agulló Vanessa, García-Abellán Javier, Telenti Guillermo, Padilla Sergio, Gutiérrez Félix, Masiá Mar
Infectious Diseases Unit, Hospital General de Elche, Clinical Medicine Department, Universidad Miguel Hernández, Alicante, Spain.
Statistics, Operative Research Center, Universidad Miguel Hernández, Alicante, Spain.
Open Forum Infect Dis. 2019 Nov 13;6(12):ofz491. doi: 10.1093/ofid/ofz491. eCollection 2019 Dec.
Integrase strand transfer inhibitors (INSTI) have been associated with weight gain, but their effect on short-term overweight and obesity incidence, blood pressure (BP), and metabolic markers has not been described in treatment-naïve people with HIV(PWH).
Medical records of treatment-naïve persons starting antiretroviral therapy (ART) at the HIV Clinic of University Hospital of Elche, Spain, between January 2007 and July 2019 were reviewed retrospectively. Standard procedures included measurements of weight, BP, and metabolic assessment. Data at baseline, 48, 72, and 96 weeks post ART initiation were analyzed. We used Cox mixed-effects model to generate predictions of body mass index (BMI) over time and generalized additive mixed models to relax the linearity assumptions and generate 95% confidence intervals in the multivariable adjustment.
Among 219 (median age, 44.0 years; interquartile range [IQR], 37.0-53.5; 46 females) participants. Baseline weight mean (standard deviation) was 70.4 (13.7) kg without difference between regimens; 66% had a BMI <25 kg/mt. The incidence of overweight and obesity was significantly greater in persons starting INSTI-based regimens: 15 (36.6%) of 41 patients treated with INSTI versus 30 (28.9%) of 104 treated with other ART regimens (hazard ratio, 2.3; 95% CI, 1.2-4.4; = .011). In contrast to other ART regimens, patients treated with INSTI showed a significant increase in systolic BP (SBP) (adjusted increase, 7.0 mmHg; 95% CI, 0.3-13.7; = .039) that was correlated with weight gain ( = 0.13; 95% CI, 0.10-0.16; < .001). Patients who reached overweight and obesity in INSTI-based ART showed a significant increase in LDL cholesterol.
Integrase strand transfer inhibitors-based ART was associated in the short-term with a greater risk of overweight and obesity and SBP elevation. Patients developing overweight and obesity increased low-density lipoprotein cholesterol with no other metabolic disturbances.
整合酶链转移抑制剂（INSTI）与体重增加有关，但其对初治艾滋病毒感染者（PWH）的短期超重和肥胖发病率、血压（BP）及代谢指标的影响尚未见报道。
回顾性分析2007年1月至2019年7月在西班牙埃尔切大学医院艾滋病毒诊所开始抗逆转录病毒治疗（ART）的初治患者的病历。标准程序包括体重、血压测量及代谢评估。分析ART开始时、开始后48周、72周和96周的数据。我们使用Cox混合效应模型生成体重指数（BMI）随时间变化的预测值，并使用广义相加混合模型放宽线性假设，在多变量调整中生成95%置信区间。
219名参与者（中位年龄44.0岁；四分位间距[IQR]为37.0 - 53.5；46名女性）。基线体重均值（标准差）为70.4（13.7）kg，各治疗方案间无差异；66%的人体重指数（BMI）<25kg/m²。开始基于INSTI方案治疗的患者超重和肥胖发生率显著更高：41名接受INSTI治疗的患者中有15名（36.6%），而104名接受其他ART方案治疗的患者中有30名（28.9%）（风险比为2.3；95%置信区间为1.2 - 4.4；P = 0.011）。与其他ART方案不同，接受INSTI治疗的患者收缩压（SBP）显著升高（校正后升高7.0mmHg；95%置信区间为0.3 - 13.7；P = 0.039），且与体重增加相关（r = 0.13；95%置信区间为0.10 - 0.16；P < 0.001）。在基于INSTI的ART治疗中达到超重和肥胖的患者低密度脂蛋白胆固醇显著升高。
基于整合酶链转移抑制剂的ART在短期内与超重和肥胖风险增加以及SBP升高有关。发生超重和肥胖的患者低密度脂蛋白胆固醇升高，无其他代谢紊乱。
