School of Public Health, Shenzhen University Medical School, Shenzhen, China.
Department of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Shenzhen Third People's Hospital, Shenzhen, China.
Front Public Health. 2023 Oct 10;11:1186838. doi: 10.3389/fpubh.2023.1186838. eCollection 2023.
With the early initiation of antiretroviral therapy (ART) in China, the demographics of treatment-naïve people living with HIV (PLWH) are moving closer to those of the general population, which is characterized by a gradual increase in metabolic indicators. However, the epidemic trends of overweight and obesity over the past decade in treatment-naïve PLWH ready to initiate ART have not yet been investigated.
A cross-sectional study was conducted, including 12,135 consecutive treatment-naïve PLWH ready to initiate ART in Shenzhen, using data retrieved from the China National Free Antiretroviral Treatment Program database from 2014 to 2020. The chi-square test was used to examine the trends of overweight and obesity between age groups, and multivariate logistic regression was used to identify the association of overweight and obesity with hyperglycemia and dyslipidemia.
During the 7-year study period, 12,135 treatment-naïve PLWH ready to initiate ART were included, among whom 1,837 (15.1%) were overweight and 388 (3.2%) were obese. The prevalence of overweight rose from 11.4 to 17.3% ( = -4.58, for trend <0.01) and that of obesity from 2.0% to 4.2% ( = -6.45, for trend <0.01) from 2014 to 2020. The annual prevalence of overweight was the highest in the age group of participants >35 years compared to prevalence in other age groups during the period 2014-2020. Compared with those who were not overweight or obese, PLWH who were overweight or obese were more likely to have hyperglycemia (aOR 1.84, 95% CI: 1.37-2.49 for overweight; aOR 2.68, 95% CI: 1.62-4.44 for obesity), higher ALT level (aOR 2.70, 95% CI: 2.33-3.13 for overweight; aOR 3.85, 95% CI: 2.93-5.05 for obesity), higher TG levels (aOR 1.89, 95% CI 1.63-2.19 for overweight; aOR 2.56, 95% CI 1.97-3.32 for obesity), and lower HDL levels (aOR 1.67, 95% CI 1.44-1.95 for overweight; aOR 2.06, 95% CI 1.54-2.77 for obesity).
The prevalence of overweight and obesity in treatment-naive PLWH increased steadily from 2014 to 2020 in Shenzhen. Overweight and obese in treatment-naive PLWH ready to initiate ART were associated with dyslipidemia and hyperglycemia. Public health authorities should take proactive steps to address these issues by implementing targeted screening, intervention programs including lifestyle modifications, and integrated healthcare services.
随着中国抗逆转录病毒治疗（ART）的早期启动，治疗初治的 HIV 感染者（PLWH）的人口统计学特征越来越接近一般人群，其特点是代谢指标逐渐增加。然而，过去十年中，准备开始 ART 的治疗初治 PLWH 中超重和肥胖的流行趋势尚未得到调查。
本研究采用 2014 年至 2020 年中国国家免费抗逆转录病毒治疗项目数据库中的数据，对深圳市 12135 名准备开始 ART 的治疗初治 PLWH 进行了一项横断面研究。采用卡方检验比较不同年龄组之间超重和肥胖的趋势，采用多变量 logistic 回归分析超重和肥胖与高血糖和血脂异常的相关性。
在 7 年的研究期间，共纳入 12135 名准备开始 ART 的治疗初治 PLWH，其中 1837 名（15.1%）超重，388 名（3.2%）肥胖。超重的患病率从 2014 年的 11.4%上升至 2020 年的 17.3%（= -4.58，趋势检验<0.01），肥胖的患病率从 2.0%上升至 4.2%（= -6.45，趋势检验<0.01）。2014 年至 2020 年期间，35 岁以上年龄组的超重患病率最高。与非超重或肥胖者相比，超重或肥胖的 PLWH 更有可能患有高血糖（超重的优势比 [aOR] 1.84，95%置信区间：1.37-2.49；肥胖的 aOR 2.68，95%CI：1.62-4.44）、更高的丙氨酸转氨酶水平（超重的 aOR 2.70，95%CI：2.33-3.13；肥胖的 aOR 3.85，95%CI：2.93-5.05）、更高的甘油三酯水平（超重的 aOR 1.89，95%CI 1.63-2.19；肥胖的 aOR 2.56，95%CI 1.97-3.32）和更低的高密度脂蛋白水平（超重的 aOR 1.67，95%CI 1.44-1.95；肥胖的 aOR 2.06，95%CI 1.54-2.77）。
深圳市准备开始 ART 的治疗初治 PLWH 中，超重和肥胖的患病率从 2014 年至 2020 年稳步上升。准备开始 ART 的治疗初治 PLWH 超重和肥胖与血脂异常和高血糖有关。公共卫生部门应采取积极措施，通过实施有针对性的筛查、包括生活方式改变在内的干预计划以及综合医疗服务来解决这些问题。
