Meena Durga S, Rai Madhukar, Singh Surya K, Tapadar Jaya, Kumar Deepak
Department of Medicine, All India Institute of Medical Sciences, Jodhpur, Rajsthan, India.
Department of Medicine, Institute of Medical Sciences, BHU, Varanasi, Uttar Pradesh, India.
J Family Med Prim Care. 2020 Mar 26;9(3):1550-1554. doi: 10.4103/jfmpc.jfmpc_1208_19. eCollection 2020 Mar.
In India, there is a genetic predisposition to insulin resistance and cardiovascular risk, the impact of ART (antiretroviral therapy) on lipid profile and blood sugar may be significant. The study of potential implications of highly active antiretroviral therapy (HAART)-associated metabolic syndrome is critical to prevent cardiovascular diseases in the Indian population.
This study was done to determine the prevalence of metabolic changes (dyslipidaemia, hyperglycemia and insulin resistance) among HIV patients on second-line ART.
A prospective cohort study.
We enrolled 150 patients, who were started on second-line HAART. Patients were investigated for fasting blood sugar, lipid profile and insulin level at baseline and after 6 months.
The data were analysed using SPSS software (version 20; IBM Corp., Armonk, N.Y., USA). Student's -test was used to compare numerical variables in the two groups. value < 0.05 was considered as statistically significant.
There was a significant increase in serum cholesterol, LDL and triglyceride in patients with protease inhibitors (PIs) containing regimens. LDL levels were increased from 65 to 80 mg/dL ( = <.003) after treatment. Triglycerides were increased from 138 to 152 mg/dL. ( = <0.001). Median fasting blood sugar was increased from 85 to 96 mg/dL ( = <0.002). HOMA-IR was also significantly increased in the PI group (1.54 vs. 2.1, <.003). However, serum HDL did not change significantly.
Appropriate drug selection with timely switching of ART is crucial to prevent metabolic complications in patients taking long-term PIs.
在印度，存在胰岛素抵抗和心血管疾病风险的遗传易感性，抗逆转录病毒疗法（ART）对血脂和血糖的影响可能很大。研究高效抗逆转录病毒疗法（HAART）相关代谢综合征的潜在影响对于预防印度人群的心血管疾病至关重要。
本研究旨在确定接受二线ART治疗的HIV患者中代谢变化（血脂异常、高血糖和胰岛素抵抗）的患病率。
一项前瞻性队列研究。
我们纳入了150例开始接受二线HAART治疗的患者。在基线和6个月后对患者进行空腹血糖、血脂和胰岛素水平检测。
使用SPSS软件（版本20；美国纽约州阿蒙克市IBM公司）对数据进行分析。采用学生t检验比较两组的数值变量。P值<0.05被认为具有统计学意义。
接受含蛋白酶抑制剂（PI）方案治疗的患者血清胆固醇、低密度脂蛋白（LDL）和甘油三酯显著升高。治疗后LDL水平从65mg/dL升至80mg/dL（P<0.003）。甘油三酯从138mg/dL升至152mg/dL（P<0.001）。空腹血糖中位数从85mg/dL升至96mg/dL（P<0.002）。PI组的胰岛素抵抗稳态模型评估（HOMA-IR）也显著升高（1.54对2.1，P<0.003）。然而，血清高密度脂蛋白（HDL）没有显著变化。
对于长期服用PI的患者，选择合适的药物并及时更换ART对于预防代谢并发症至关重要。
