中国 HIV 感染者接受抗逆转录病毒治疗后血脂异常的风险因素及纵向变化。
Risk factors and longitudinal changes of dyslipidemia among Chinese people living with HIV receiving antiretroviral therapy.
机构信息
Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Wangfujing Street, Beijing, 100730, China.
Clinical Immunology Center, Chinese Academy of Medical Sciences, Beijing, China.
出版信息
BMC Infect Dis. 2023 Sep 13;23(1):598. doi: 10.1186/s12879-023-08587-0.
BACKGROUND
Antiretroviral therapy (ART) improved the prognosis of people living with human immunodeficiency virus (HIV) (PLWH). Life-long treatment is required in PLWH and is accompanied by various metabolic abnormalities in the disease course. Data about the epidemiology and the dynamic changes of dyslipidemia in PLWH receiving antiretroviral therapy were scarce in Asian countries. This study aimed to explore the risk factors of dyslipidemia and analyze the longitudinal changes of dyslipidemia among Chinese PLWH receiving HAART.
METHODS
We conducted a longitudinal analysis of PLWH enrolled in two large multicenter clinical trials across China, and outpatients followed at the clinic of Peking Union Medical College Hospital. Demographic data and clinical parameters were collected. The risk factors and longitudinal changes in lipid profiles associated with HIV-1 infection were analyzed. The definition of dyslipidemia was made based on the National Cholesterol Education Program, Adult Treatment Panel (NCEP-ATP) III guidelines.
RESULTS
A total of 1542 PLWH were included. The median follow-up was 6 years. At baseline, the concentrations of total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) were 4.1 ± 0.91 mmol/L, 1.2 (interquartile ranges [IQR] 0.85-1.75) mmol/L, 1.1 ± 0.37 and 2.4 ± 0.76 mmol/L, respectively. The rate of hypercholesterolemia, hyperglyceridemia, high LDL-C, and low HDL-C were 10.18%, 26.39%, 9.08%, and 44.94%, respectively. The overall prevalence of dyslipidemia was 69.3%, which raised to 84.3% after antiretroviral therapy, substantially higher. CD4/CD8 ratio < 0.3 and viral load > 10 copies/mL were risk factors associated with any subtype of dyslipidemia. A negative correlation between CD8CD38 percentage and HDL-C concentration was found. The regimens including efavirenz (EFV) and tenofovir (TDF) showed better lipid profiles. Longitudinal analysis revealed that both the level and the percentage of abnormal TG and HDL-C occurred drastic change in the first 6 months after ART initiation (from 4.07 to 4.41, from 1.11 to 1.28mmol/L, from 26.39 to 31.1% and from 44.94 to 29.5%, respectively).
CONCLUSIONS
The prevalence of dyslipidemia is high in PLWH and increases after ART, mainly represented as high TG and low HDL-C and associated with advanced stage of HIV-1 infection. The greatest changes in lipids occurred in the early stage after initiating ART therapy. The results suggest that dyslipidemia should be monitored and managed when starting ART.
背景
抗逆转录病毒疗法（ART）改善了人类免疫缺陷病毒（HIV）感染者（PLWH）的预后。PLWH 需要终身治疗，并且在疾病过程中会伴随各种代谢异常。亚洲国家关于接受抗逆转录病毒治疗的 PLWH 血脂异常的流行病学和动态变化的数据很少。本研究旨在探讨血脂异常的危险因素，并分析中国接受 HAART 的 PLWH 血脂异常的纵向变化。
方法
我们对在中国两个大型多中心临床试验中招募的 PLWH 进行了纵向分析，并对北京协和医院门诊的患者进行了随访。收集人口统计学数据和临床参数。分析了与 HIV-1 感染相关的血脂谱的危险因素和纵向变化。血脂异常的定义基于国家胆固醇教育计划，成人治疗专家组（NCEP-ATP）III 指南。
结果
共纳入 1542 例 PLWH。中位随访时间为 6 年。基线时，总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）和低密度脂蛋白胆固醇（LDL-C）的浓度分别为 4.1±0.91mmol/L、1.2（四分位距 [IQR] 0.85-1.75）mmol/L、1.1±0.37mmol/L 和 2.4±0.76mmol/L。高胆固醇血症、高甘油三酯血症、高 LDL-C 和低 HDL-C 的发生率分别为 10.18%、26.39%、9.08%和 44.94%。血脂异常的总体患病率为 69.3%，抗逆转录病毒治疗后升高至 84.3%，显著更高。CD4/CD8 比值<0.3 和病毒载量>10 拷贝/mL 是与任何类型血脂异常相关的危险因素。发现 CD8CD38 百分比与 HDL-C 浓度呈负相关。包含依非韦伦（EFV）和替诺福韦（TDF）的方案显示出更好的血脂谱。纵向分析显示，ART 治疗开始后 6 个月内，TG 和 HDL-C 的水平和异常百分比均发生剧烈变化（分别从 4.07 升至 4.41mmol/L，从 1.11 升至 1.28mmol/L，从 26.39%升至 31.1%，从 44.94%降至 29.5%）。
结论
PLWH 血脂异常的患病率较高，抗逆转录病毒治疗后会升高，主要表现为高 TG 和低 HDL-C，与 HIV-1 感染的晚期有关。ART 治疗开始后早期血脂变化最大。结果提示，开始 ART 治疗时应监测和管理血脂异常。
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