亚洲成年人 HIV 感染者体重变化、代谢综合征与全因死亡率。
Weight changes, metabolic syndrome and all-cause mortality among Asian adults living with HIV.
机构信息
The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia.
HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand.
出版信息
HIV Med. 2022 Mar;23(3):274-286. doi: 10.1111/hiv.13211. Epub 2021 Nov 23.
OBJECTIVES
We investigated weight changes following antiretroviral therapy (ART) initiation, the development of metabolic syndrome (MetS) and its association with all-cause mortality among Asian adults living with HIV.
METHODS
Participants enrolled in a regional Asian HIV-infected cohort with weight and height measurements at ART initiation were eligible for inclusion in the analysis. Factors associated with weight changes and incident MetS (according to the International Diabetic Federation (IDF) definition) were analysed using linear mixed models and Cox regression, respectively. Competing-risk regression models were used to investigate the association of MetS with all-cause mortality.
RESULTS
Among 4931 people living with HIV (PLWH), 66% were male. At ART initiation, the median age was 34 [interquartile range (IQR) 29-41] years, and the median (IQR) weight and body mass index (BMI) were 55 (48-63) kg and 20.5 (18.4-22.9) kg/m , respectively. At 1, 2 and 3 years of ART, overall mean (± standard deviation) weight gain was 2.2 (±5.3), 3.0 (±6.2) and 3.7 (±6.5) kg, respectively. Participants with baseline CD4 count ≤ 200 cells/µL [weight difference (diff) = 2.2 kg; 95% confidence interval (CI) 1.9-2.5 kg] and baseline HIV RNA ≥ 100 000 HIV-1 RNA copies/mL (diff = 0.6 kg; 95% CI 0.2-1.0 kg), and those starting with integrase strand transfer inhibitor (INSTI)-based ART (diff = 2.1 kg; 95% CI 0.7-3.5 kg vs. nonnucleoside reverse transcriptase inhibitors) had greater weight gain. After exclusion of those with abnormal baseline levels of MetS components, 295/3503 had incident MetS [1.18 (95% CI 1.05-1.32)/100 person-years (PY)]. The mortality rate was 0.7 (95% CI 0.6-0.8)/100 PY. MetS was not significantly associated with all-cause mortality in the adjusted model (P = 0.236).
CONCLUSIONS
Weight gain after ART initiation was significantly higher among those initiating ART with lower CD4 count, higher HIV RNA and an INSTI-based regimen after controlling for baseline BMI. Greater efforts to identify and manage MetS among PLWH are needed.
目的
本研究旨在调查接受抗逆转录病毒疗法（ART）后体重的变化，代谢综合征（MetS）的发生及其与亚洲 HIV 感染者全因死亡率的关系。
方法
本研究纳入了参加亚洲 HIV 感染队列研究且在接受 ART 治疗时测量了体重和身高的患者。采用线性混合模型和 Cox 回归分析分别评估与体重变化和新发 MetS（根据国际糖尿病联合会（IDF）定义）相关的因素。采用竞争风险回归模型探讨 MetS 与全因死亡率的关系。
结果
在 4931 名 HIV 感染者（PLWH）中，66%为男性。ART 治疗开始时，患者的中位年龄为 34 岁[四分位间距（IQR）29-41]，体重和体重指数（BMI）的中位数（IQR）分别为 55（48-63）kg 和 20.5（18.4-22.9）kg/m 。在 ART 治疗 1、2 和 3 年时，体重的平均（±标准差）增加量分别为 2.2（±5.3）kg、3.0（±6.2）kg 和 3.7（±6.5）kg。与基线 CD4 计数≤200 个细胞/μL[体重差值（diff）=2.2 kg；95%置信区间（CI）1.9-2.5 kg]和基线 HIV RNA≥100 000 HIV-1 RNA 拷贝/mL（diff=0.6 kg；95%CI 0.2-1.0 kg）的患者以及起始使用整合酶抑制剂（INSTI）的患者相比，体重增加更为显著（diff=2.1 kg；95%CI 0.7-3.5 kg vs. 非核苷类逆转录酶抑制剂）。在排除基线 MetS 成分异常的患者后，3503 名患者中有 295 名（1.18[95%CI 1.05-1.32]/100 人年（PY））发生 MetS。死亡率为 0.7（95%CI 0.6-0.8）/100 PY。校正模型中，MetS 与全因死亡率无显著相关性（P=0.236）。
结论
在控制基线 BMI 后，CD4 计数较低、HIV RNA 较高且起始使用 INSTI 方案的患者，ART 治疗后体重增加更为显著。需要进一步努力识别和管理 HIV 感染者的 MetS。
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