在新冠疫情期间，艾滋病毒感染者代谢综合征的发病率和患病率不断上升。

Increasing incidence and prevalence of metabolic syndrome in people living with HIV during the COVID-19 pandemic.

作者信息

Papaioannu Borjesson Rebecka, Galli Laura, Muccini Camilla, Poli Andrea, Clemente Tommaso, Bottanelli Martina, Gianotti Nicola, Nozza Silvia, Castagna Antonella, Spagnuolo Vincenzo

机构信息

School of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy.

Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy.

出版信息

Front Med (Lausanne). 2023 Sep 18;10:1220631. doi: 10.3389/fmed.2023.1220631. eCollection 2023.

DOI:10.3389/fmed.2023.1220631

PMID:37790130

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10544903/

Abstract

INTRODUCTION

The aim of this study was to analyze the impact of COVID-19 pandemic restrictions on the prevalence and incidence of metabolic syndrome (MS), and to identify predictors of new MS cases in people living with HIV (PLWH).

METHODS

This cohort study included PLWH followed at the IRCCS San Raffaele, Milan, Italy, with at least one body mass index (BMI) determination during the pre-pandemic period (1 December 2018 to 29 February 2020) and the pandemic period (1 March 2020 to 31 May 2021). MS diagnosis was based on NCEP ATP III 2005 criteria. Univariable Poisson regression model was used to compare MS incidence rates. Univariable mixed linear models estimated the crude mean change in metabolic parameters during each time period. Multivariable Cox proportional hazards model was used to assess risk factors for MS.

RESULTS

This study included 1,564 PLWH, of whom 460 and 1,104 were with and without a diagnosis of MS, respectively, at the beginning of the pre-pandemic period, with an overall prevalence of MS of 29.4%. During the pre-pandemic period, 528/1,564 PLWH had MS, with a prevalence of 33.8% (95%CI = 31.5%-36.1%), while during the pandemic period, the number of PLWH with a diagnosis of MS increased to 628/1,564, with a prevalence of 40.2% (95%CI 37.8%-42.6%; McNemar's test: < 0.0001). Similarly, the MS incidence rate increased from 13.7/100 person-years of follow-up (PYFU; 95%CI = 11.7-16.0) in the pre-pandemic period to 18.5/100 PYFU (95%CI = 16.2-21.1) in the pandemic period ( = 0.004), with 201 subjects developing MS during the pandemic period. In addition, we observed a significant increase in the crude mean change during the pandemic period compared with the pre-pandemic period for: total cholesterol, LDL cholesterol, plasma glucose, blood pressure, and atherosclerotic cardiovascular disease (ASCVD) risk score. Finally, after adjustment for HIV risk factors, HBV, HCV, ART duration, duration of virologic suppression and use of INSTIs, age [adjusted hazard ratio (AHR) per 3 years older = 1.12 (95%CI = 1.08-1.17)], sex [AHR female vs. male = 0.62 (95%CI = 0.44-0.87)] and CD4+ cell count [AHR per 100 cells/μL higher = 1.05 (95%CI = 1.01-1.09)] were associated with the risk of MS.

CONCLUSION

The COVID-19 pandemic affected the metabolic profile of PLWH and increased the prevalence and incidence of MS.

摘要

引言

本研究旨在分析2019冠状病毒病（COVID-19）大流行限制措施对代谢综合征（MS）患病率和发病率的影响，并确定人类免疫缺陷病毒（HIV）感染者（PLWH）中新发MS病例的预测因素。

方法

这项队列研究纳入了在意大利米兰圣拉斐尔科学研究所（IRCCS San Raffaele）接受随访的PLWH，他们在大流行前时期（2018年12月1日至2020年2月29日）和大流行时期（2020年3月1日至2021年5月31日）至少有一次体重指数（BMI）测定。MS诊断基于2005年美国国家胆固醇教育计划成人治疗组第三次报告（NCEP ATP III）标准。采用单变量泊松回归模型比较MS发病率。单变量混合线性模型估计了每个时间段代谢参数的粗平均变化。多变量Cox比例风险模型用于评估MS的危险因素。

结果

本研究纳入了1564例PLWH，其中在大流行前时期开始时，分别有460例和1104例被诊断为患有和未患有MS，MS总体患病率为29.4%。在大流行前时期，1564例PLWH中有528例患有MS，患病率为33.8%（95%置信区间[CI]=31.5%-36.1%），而在大流行时期，被诊断为患有MS的PLWH数量增加到628/1564例，患病率为40.2%（95%CI 37.8%-42.6%；McNemar检验：<0.0001）。同样，MS发病率从大流行前时期的13.7/100人年随访（PYFU；95%CI=11.7-16.0）增加到大流行时期的18.5/100 PYFU（95%CI=16.2-21.1）（P=0.004），在大流行时期有201名受试者患上MS。此外，我们观察到与大流行前时期相比，大流行时期以下指标的粗平均变化显著增加：总胆固醇、低密度脂蛋白胆固醇、血糖、血压和动脉粥样硬化性心血管疾病（ASCVD）风险评分。最后，在对HIV危险因素、乙型肝炎病毒（HBV）、丙型肝炎病毒（HCV）、抗逆转录病毒治疗（ART）持续时间、病毒学抑制持续时间和整合酶链转移抑制剂（INSTIs）使用情况进行调整后，年龄[每大3岁的调整后风险比（AHR）=1.12（95%CI=1.08-1.17）]、性别[AHR女性对男性=0.62（95%CI=0.44-0.87）]和CD4+细胞计数[每高100个细胞/μL的AHR=1.05（95%CI=1.01-1.09）]与MS风险相关。