南非围产期感染艾滋病毒的青少年中，动脉粥样硬化病理生物学检测水平升高的决定因素与青少年风险评分相关。
The Determinants of Elevated Pathobiological Determination of Atherosclerosis in Youth Risk Score in Perinatally HIV-Infected Adolescents in South Africa.
机构信息
Department of Pediatrics & Child Health, Red Cross War Memorial Children's Hospital, and SA MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa.
Department of Paediatrics and Child Health, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa.
出版信息
J Acquir Immune Defic Syndr. 2024 Jan 1;95(1):82-89. doi: 10.1097/QAI.0000000000003304.
BACKGROUND
Youth living with perinatally acquired HIV infection (YLPHIV) are at risk of developing atherosclerotic cardiovascular disease.
METHODS
We determined the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) coronary arteries (CA) and abdominal aorta (AA) risk scores among YLPHIV who are ≥15 years old in Cape Town Adolescent and Antiretroviral Cohort. PDAY score was calculated using non-high-density lipoprotein, high-density lipoprotein cholesterol, hyperglycemia, hypertension, obesity, and smoking; a score ≥1 was considered elevated. HIV viremia was categorized as sustained (SV) = viral load (VL) >50 copies/mL, transient (TV) = mix of VL >50 and ≤50 copies/mL, or sustained-virologic suppression = VL <50 copies/mL throughout the study. Among YLPHIV, logistic models were fit to assess factors associated with elevated PDAY.
RESULTS
Overall, 218 YLPHIV [median age 16.8 (interquartile range: 15.9-17.8) years, male 47%] were included. Among YLPHIV, 8% (n = 17) had SV, and 54% (n = 118) had TV. Median antiretroviral therapy (ART) duration was 12 (interquartile range: 8-14) years. Among YLPHIV, 30.3% and 18.4% had elevated PDAY for CA and AA, respectively.Among YLPHIV, SV [adjusted odds ratio (aOR) = 18.4, P < 0.01] and TV (aOR = 2.10, P = 0.04) compared with virologic suppression and ART duration in years (aOR = 1.12, P = 0.03) were associated with elevated CA. Male sex was associated with both elevated CA and AA (aOR = 2.14, P = 0.02, and aOR = 3.43, P = 0.01, respectively) and association of SV with elevated AA (aOR = 3.24, P = 0.09).
CONCLUSIONS
A substantial proportion of YLPHIV have PDAY scores reflecting increased aggregate atherosclerotic risk. Among YLPHIV, viremia, lifetime ART duration, and male sex contribute to this risk, highlighting the importance of HIV control and the need to monitor cardiometabolic health.
背景
感染围生期 HIV 的青年（YLPHIV）存在发生动脉粥样硬化性心血管疾病的风险。
方法
我们在开普敦青少年和抗逆转录病毒队列中确定了年龄≥15 岁的 YLPHIV 的动脉粥样硬化病理生物学决定因素青年（PDAY）冠状动脉（CA）和腹主动脉（AA）风险评分。PDAY 评分使用非高密度脂蛋白胆固醇、高密度脂蛋白胆固醇、高血糖、高血压、肥胖和吸烟计算；评分≥1 被认为升高。HIV 病毒血症分为持续（SV）=病毒载量（VL）>50 拷贝/mL、短暂（TV）=VL>50 和≤50 拷贝/mL 混合、或持续病毒学抑制=整个研究期间 VL<50 拷贝/mL。在 YLPHIV 中，拟合逻辑模型以评估与升高的 PDAY 相关的因素。
结果
总体而言，纳入了 218 名 YLPHIV[中位年龄 16.8（四分位间距：15.9-17.8）岁，男性 47%]。在 YLPHIV 中，8%（n=17）为 SV，54%（n=118）为 TV。中位抗逆转录病毒治疗（ART）持续时间为 12（四分位间距：8-14）年。在 YLPHIV 中，CA 和 AA 的 PDAY 分别升高 30.3%和 18.4%。在 YLPHIV 中，SV[校正优势比（aOR）=18.4，P<0.01]和 TV（aOR=2.10，P=0.04）与病毒学抑制和 ART 持续时间（aOR=1.12，P=0.03）相比，与升高的 CA 相关。男性与 CA 和 AA 升高均相关（aOR=2.14，P=0.02，aOR=3.43，P=0.01），SV 与 AA 升高相关（aOR=3.24，P=0.09）。
结论
相当一部分 YLPHIV 的 PDAY 评分反映出动脉粥样硬化风险增加。在 YLPHIV 中，病毒血症、终生 ART 持续时间和男性性别促成了这种风险，强调了 HIV 控制的重要性以及监测心血管代谢健康的必要性。
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