Waritu Nuredin Chura, Nair Suresh Kumar P, Birhan Bihonegn, Adugna Tesfaye, Awgichew Gesese Bogale, Jemal Mohammed
Department of Biomedical Sciences, School of Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia.
Department of Biomedical Sciences, School of Medicine, Jimma University, Jimma, Ethiopia.
HIV AIDS (Auckl). 2024 Feb 12;16:17-32. doi: 10.2147/HIV.S430310. eCollection 2024.
Long-term use of antiretroviral therapy, especially dolutegravir and boosted-atazanavir, raises concerns about cardiovascular disease. Thus, this study aimed to assess lipid profiles, blood glucose, and high-sensitivity C-reactive protein levels among people living with HIV on dolutegravir and ritonavir-boosted atazanavir-based therapy.
An institutional-based comparative cross-sectional study was conducted from November 4, 2021, to January 4, 2022. An equal number of dolutegravir- and ritonavir-boosted atazanavir-treated patients (n = 64 each) was enrolled. A consecutive sampling was used to select participants. The Chi-square, Student's -test, Mann-Whitney -test, and logistic regression were used as appropriate statistical tests using SPSS Version 25.0. Statistical significance was set at p < 0.05.
Dyslipidemia was found in 67.2% (43/64) of ritonavir-boosted atazanavir group and 48.4% (31/64) of dolutegravir group. The dolutegravir group had significantly higher mean and median values of high-density lipoprotein and random blood sugar, respectively, as well as lower median triglyceride and high-sensitivity C-reactive protein levels than the ritonavir-boosted atazanavir group. Ritonavir-boosted atazanavir-based regimens (AOR=3.4, 95% CI: 1.5, 8) and age >40 years were predictors of dyslipidemia, while BMI ≥25 kg/m (AOR=3.7, 95% CI: 1.3, 10.8) and dolutegravir-based regimens (AOR=4.6, 95% CI: 1.5, 14) were predictors of hyperglycemia. Ritonavir-boosted atazanavir-based regimens (ARR=3, 95% CI: 1.3, 8) and BMI ≥25 kg/m (ARR=2.5, 95% CI: 1.1, 6) were associated with increased high-sensitivity C-reactive protein by 1-3 mg/L. The risk of increased high-sensitivity C-reactive protein by >3 mg/L was greater in those patients with a CD4 cell count of <500 cells/mm (ARR=5, 95% CI: 1.1, 24).
When compared to ritonavir-boosted atazanavir-based regimens, dolutegravir had favorable lipid profiles and high-sensitivity C-reactive protein but unfavorable blood glucose levels. Therefore, baseline blood glucose, lipid profiles, and high-sensitivity C-reactive protein levels should be routinely measured in patients on these regimens.
长期使用抗逆转录病毒疗法，尤其是多替拉韦和利托那韦增强的阿扎那韦，引发了人们对心血管疾病的担忧。因此，本研究旨在评估接受基于多替拉韦和利托那韦增强的阿扎那韦治疗的HIV感染者的血脂谱、血糖和高敏C反应蛋白水平。
于2021年11月4日至2022年1月4日进行了一项基于机构的比较横断面研究。纳入了数量相等的接受多替拉韦和利托那韦增强的阿扎那韦治疗的患者（每组n = 64）。采用连续抽样的方法选择参与者。使用SPSS 25.0软件，根据情况分别采用卡方检验、学生t检验、曼-惠特尼U检验和逻辑回归作为统计检验方法。设定统计学显著性为p < 0.05。
在利托那韦增强的阿扎那韦组中，67.2%（43/64）的患者存在血脂异常，在多替拉韦组中，48.4%（31/64）的患者存在血脂异常。与利托那韦增强的阿扎那韦组相比，多替拉韦组的高密度脂蛋白平均和中位数水平以及随机血糖水平显著更高，同时甘油三酯中位数和高敏C反应蛋白水平更低。基于利托那韦增强的阿扎那韦的治疗方案（调整后比值比[AOR]=3.4，95%置信区间[CI]：1.5，8）和年龄>40岁是血脂异常的预测因素，而体重指数（BMI）≥25 kg/m²（AOR=3.7，95% CI：1.3，10.8）和基于多替拉韦的治疗方案（AOR=4.6，95% CI：1.5，14）是高血糖的预测因素。基于利托那韦增强的阿扎那韦的治疗方案（归因风险率[ARR]=3，95% CI：1.3，8）和BMI≥25 kg/m²（ARR=2.5，95% CI：1.1，6）与高敏C反应蛋白升高1 - 3 mg/L相关。CD4细胞计数<500个细胞/mm³的患者高敏C反应蛋白升高>3 mg/L的风险更大（ARR=5，95% CI：1.1，24）。
与基于利托那韦增强的阿扎那韦的治疗方案相比，多替拉韦具有良好的血脂谱和高敏C反应蛋白水平，但血糖水平不理想。因此，对于接受这些治疗方案的患者，应常规测量基线血糖、血脂谱和高敏C反应蛋白水平。
