整合酶抑制剂的使用、体重指数、身体活动和热量摄入对 HIV 感染者体重增加的影响。

Contribution of integrase inhibitor use, body mass index, physical activity and caloric intake to weight gain in people living with HIV.

机构信息

Modena HIV Metabolic Clinic, Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy.

Infectious Diseases Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy.

出版信息

HIV Res Clin Pract. 2022 Nov 22;24(1):1-6.

PMID:36883678

Abstract

Integrase inhibitor (INSTI) use has been associated with greater weight gain (WG) among people living with HIV (PLWH), but it is unclear how this effect compares in magnitude to traditional risk factors for WG. We assessed the population attributable fractions (PAFs) of modifiable lifestyle factors and INSTI regimens in PLWH who experienced a ≥5% WG over follow-up. In an observational cohort study from 2007 to 2019 at Modena HIV Metabolic Clinic, Italy, ART-experienced but INSTI-naive PLWH were grouped as INSTI-switchers vs non-INSTI. Groups were matched for sex, age, baseline BMI and follow-up duration. Significant WG was defined as an increase of ≥5% from 1st visit weight over follow-up. PAFs and 95% CIs were estimated to quantify the proportion of the outcome that could be avoided if the risk factors were not present. 118 PLWH switched to INSTI and 163 remained on current ART. Of 281 PLWH (74.3% males), mean follow-up was 4.2 years, age 50.3 years, median time since HIV diagnosis 17.8 years, CD4 cell count 630 cells/µL at baseline. PAF for weight gain was the greatest for high BMI (45%, 95% CI: 27-59, < 0.001), followed by high CD4/CD8 ratio (41%, 21-57, < 0.001) and lower physical activity (32%, 95% CI 5-52, = 0.03). PAF was not significant for daily caloric intake (-1%, -9-13, = 0.45), smoking cessation during follow-up (5%, 0-12, = 0.10), INSTI switch (11%, -19-36; = 0.34). WG in PLWH on ART is mostly influenced by pre-existing weight and low physical activity, rather than switch to INSTI.

摘要

整合酶抑制剂（INSTI）的使用与 HIV 感染者（PLWH）体重增加（WG）有关，但尚不清楚这种影响与 WG 的传统危险因素相比有多大。我们评估了在随访期间经历 WG 增加≥5%的 PLWH 中，可改变的生活方式因素和 INSTI 方案的人群归因分数（PAF）。在意大利摩德纳 HIV 代谢诊所 2007 年至 2019 年的一项观察性队列研究中，将接受过 ART 但未使用过 INSTI 的 PLWH 分为 INSTI 转换者和非 INSTI 组。两组按性别、年龄、基线 BMI 和随访时间匹配。显著 WG 定义为从第 1 次就诊体重增加≥5%。估计 PAF 和 95%CI 以量化如果不存在危险因素，结果中可以避免的比例。118 名 PLWH 转为 INSTI，163 名仍使用当前 ART。在 281 名 PLWH（74.3%为男性）中，平均随访时间为 4.2 年，年龄为 50.3 岁，从 HIV 诊断到基线时的中位时间为 17.8 年，CD4 细胞计数为 630 个/μL。体重增加的 PAF 最高的是高 BMI（45%，95%CI：27-59， < 0.001），其次是高 CD4/CD8 比值（41%，21-57， < 0.001）和较低的体力活动（32%，95%CI 5-52， = 0.03）。每日热量摄入（-1%，-9-13， = 0.45）、随访期间戒烟（5%，0-12， = 0.10）、INSTI 转换（11%，-19-36； = 0.34）的 PAF 均无统计学意义。ART 治疗的 PLWH 中，WG 主要受体重和低体力活动的影响，而不是改用 INSTI。