Beijing Ditan Hospital, Capital Medical University, Beijing, China.
Clinical Center for HIV/AIDS, Capital Medical University, Beijing, China.
HIV Med. 2022 Mar;23 Suppl 1:32-41. doi: 10.1111/hiv.13247.
We aimed to analyze the incidence rates of new-onset diabetes, hypertriglyceridemia, hypercholesterolemia, liver injury, and renal injury during antiretroviral therapy (ART) among people living with HIV (PLWH) and determine the associated risk factors.
This study included PLWH enrolled from Beijing Ditan Hospital from November 11, 2004, to December 29, 2018. The incidence rates of new-onset diabetes, hypertriglyceridemia, hypercholesterolemia, liver injury, and renal injury were calculated and stratified based on ART regimen, CD4 count, and HIV-RNA. Risk factors were determined using Cox regression analysis.
Overall, 6747 participants were included. Moreover, 4.5%, 43.3%, 25.4%, 11.2%, and 6.2% of patients developed new-onset diabetes, hypertriglyceridemia, hypercholesterolemia, liver injury, and renal injury, respectively, with incidence rates of 1.7, 26.9, 10.2, 3.9, and 5.5 per 100 person-years, respectively. Longitudinally, the incidence rates and percentages of these outcomes were highest in the first year of ART. The percentage of dyslipidemia was significantly higher in protease inhibitor (PI)-based regimen than in non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimen. However, the percentage of liver injury was significantly higher in NNRTI-based regimen than in PI-based regimen. In multivariate Cox regression analysis, low CD4 count (<200 cells/µL, adjusted hazard ratio [aHR] = 1.34, 95% confidence interval [CI] 1.15-1.57) and high HIV-RNA (>10 copies/mL, aHR = 1.26, 95% CI 1.08-1.48) were risk factors for hypertriglyceridemia.
Clinical outcomes, including new-onset diabetes, dyslipidemia, and liver and renal injuries, are common in PLWH. Regular glucose, lipid, liver, and renal function monitoring is required during ART, especially in high-risk patients.
分析艾滋病毒感染者（PLWH）在抗逆转录病毒治疗（ART）期间新发糖尿病、高甘油三酯血症、高胆固醇血症、肝损伤和肾损伤的发生率，并确定相关的危险因素。
本研究纳入了 2004 年 11 月 11 日至 2018 年 12 月 29 日期间在北京地坛医院就诊的 PLWH。根据 ART 方案、CD4 计数和 HIV-RNA 计算并分层了新发糖尿病、高甘油三酯血症、高胆固醇血症、肝损伤和肾损伤的发生率。采用 Cox 回归分析确定危险因素。
共有 6747 名患者纳入研究。此外，分别有 4.5%、43.3%、25.4%、11.2%和 6.2%的患者发生了新发糖尿病、高甘油三酯血症、高胆固醇血症、肝损伤和肾损伤，其发生率分别为 1.7、26.9、10.2、3.9 和 5.5 例/100 人年。纵向来看，ART 治疗的第一年这些结果的发生率和比例最高。基于蛋白酶抑制剂（PI）的方案中血脂异常的比例明显高于基于非核苷类逆转录酶抑制剂（NNRTI）的方案，而基于 NNRTI 的方案中肝损伤的比例明显高于基于 PI 的方案。在多变量 Cox 回归分析中，低 CD4 计数（<200 个细胞/µL，调整后的危险比[aHR] = 1.34，95%置信区间[CI] 1.15-1.57）和高 HIV-RNA（>10 拷贝/mL，aHR = 1.26，95%CI 1.08-1.48）是高甘油三酯血症的危险因素。
在 PLWH 中，常见的临床结局包括新发糖尿病、血脂异常以及肝和肾损伤。在 ART 期间需要定期监测血糖、血脂、肝功能和肾功能，特别是在高危患者中。
