Mewa Kinoo Suman, Nagiah Savania, Chuturgoon Anil, Singh Bhugwan
Department of General Surgery, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
Department of Human Biology, Faculty of Health Sciences, Nelson Mandela University Missionvale, Port Elizabeth, South Africa.
South Afr J HIV Med. 2021 Mar 25;22(1):1208. doi: 10.4102/sajhivmed.v22i1.1208. eCollection 2021.
The incidence of metabolic disorders in human immunodeficiency virus (HIV) endemic settings is a prevailing burden in developing countries. Cholesterol homeostasis and fat metabolism are altered by HIV and antiretroviral therapy (ART), thereby possibly contributing to complications such as gallstone formation.
The aim of this study was to evaluate established risk factors for the formation of cholesterol gallstones in black South African women living with HIV (WLHIV).
A case series study was conducted of all black South African women undergoing cholecystectomy for gallstone disease over a 1-year period at King Edward VIII Hospital, Durban, South Africa. Age, body mass index (BMI), family history of gallstones, oestrogen exposure and lipograms were compared between WLHIV and uninfected women. Categorical variables were tested using either the Fisher's exact test or Pearson's chi-square test. Means were compared using independent -tests. For non-normally distributed data, the Mann-Whitney U test was used. Statistical tests were two-sided, and -values of less than 0.05 were considered statistically significant.
A total of 52 patients were assessed, 34 HIV-uninfected and 18 WLHIV. The median age of WLHIV versus the uninfected women was 35 and 50 years, respectively, ( = 0.015). A statistically significant number of uninfected women were in the overweight/obese category (BMI > 25 kg/m) compared to the normal weight category (BMI < 25 kg/m) ( < 0.001). The number of obese WLHIV did not reach statistical significance.
The age of occurrence of gallstone disease amongst black South African WLHIV was significantly lower and fewer women were obese compared with the uninfected women with gallstone disease. These findings differ from known gallstone risk factors in other populations and in uninfected black South African women. This could be attributed to the metabolic alterations caused by HIV infection itself and/or to the long-term use of ART. Larger cohort studies are required to elucidate the role of HIV and ART in cholestatic disease.
在人类免疫缺陷病毒（HIV）流行地区，代谢紊乱的发生率是发展中国家普遍存在的负担。HIV和抗逆转录病毒疗法（ART）会改变胆固醇稳态和脂肪代谢，从而可能导致胆结石形成等并发症。
本研究旨在评估南非黑人HIV感染女性（WLHIV）中胆固醇胆结石形成的既定风险因素。
在南非德班爱德华八世医院，对所有在1年期间因胆结石疾病接受胆囊切除术的南非黑人女性进行了一项病例系列研究。比较了WLHIV和未感染女性的年龄、体重指数（BMI）、胆结石家族史、雌激素暴露情况和血脂谱。分类变量使用Fisher精确检验或Pearson卡方检验进行检验。均值使用独立样本t检验进行比较。对于非正态分布的数据，使用Mann-Whitney U检验。统计检验为双侧检验，P值小于0.05被认为具有统计学意义。
共评估了52例患者，34例未感染HIV，18例WLHIV。WLHIV与未感染女性的中位年龄分别为35岁和50岁（P = 0.015）。与正常体重类别（BMI < 25 kg/m²）相比，未感染女性中超重/肥胖类别的数量具有统计学意义（P < 0.001）。肥胖的WLHIV数量未达到统计学意义。
与患有胆结石疾病的未感染女性相比，南非黑人WLHIV中胆结石疾病的发病年龄显著更低，肥胖女性更少。这些发现与其他人群以及未感染的南非黑人女性中已知的胆结石风险因素不同。这可能归因于HIV感染本身引起的代谢改变和/或长期使用ART。需要更大规模的队列研究来阐明HIV和ART在胆汁淤积性疾病中的作用。
