Huzhou Center for Disease Control and Prevention, Huzhou, Zhejiang, China.
Division of Epidemiology and Health Statistics, Department of Preventive Medicine, School of Public Health & Management, Wenzhou Medical University, Wenzhou, Zhejiang, China.
PLoS One. 2024 Sep 20;19(9):e0305461. doi: 10.1371/journal.pone.0305461. eCollection 2024.
Dyslipidemia is increasingly common in people living with HIV (PLHIV), thereby increasing the risk of cardiovascular events and diminishing the quality of life for these individuals. The study of blood lipid metabolism of PLHIV has great clinical significance in predicting the risk of cardiovascular disease. Therefore, this study aims to examine the blood lipid metabolism status of HIV-infected patients in Huzhou before and after receiving highly active antiretroviral therapy (HAART) and to explore the impact of different HAART regimens on dyslipidemia.
PLHIV confirmed in Huzhou from June 2010 to June 2022 was included. The baseline characteristics and clinical data during the follow-up period were collected, including some blood lipid indicators (total cholesterol and triglycerides) and HAART regimens. A multivariate logistic regression model and the generalized estimating equation model were used to analyze the independent effects of treatment regimens on the risk of dyslipidemia.
The overall prevalence of dyslipidemia among PLHIV after HAART was 70.11%. PLHIV receiving lamivudine (3TC) + efavirenz (EFV) + zidovudine (AZT) had a higher prevalence of dyslipidemia compared to those receiving 3TC+EFV+tenofovir disoproxil fumarate (TDF). In a logistic analysis adjusted for important covariates such as BMI, age, diabetes status, etc., we found that the risks of dyslipidemia were higher with 3TC+EFV+AZT (dyslipidemia: odds ratio [OR] = 2.09, 95% confidence interval [Cl]: 1.28-3.41; TG ≥1.7: OR = 2.40, 95%Cl:1.50-3.84) than with 3TC+EFV+TDF. Furthermore, on PLHIV that was matched 1:1 by the HAART regimens, the results of the generalized estimation equation again showed that 3TC+EFV+AZT (TG ≥1.7: OR = 1.84, 95%Cl: 1.10-3.07) is higher for the risk of marginal elevations of TG than 3TC+EFV+TDF.
The prevalence of dyslipidemia varies according to different antiretroviral regimens. Using both horizontal and longitudinal data, we have repeatedly demonstrated that AZT has a more adverse effect on blood lipids than TDF from two perspectives. Therefore, we recommend caution in using the 3TC+EFV+AZT regimen for people at clinical risk of co-occurring cardiovascular disease.
血脂异常在 HIV 感染者（PLHIV）中越来越常见，从而增加了心血管事件的风险，并降低了这些个体的生活质量。研究 PLHIV 的血脂代谢对预测心血管疾病风险具有重要的临床意义。因此，本研究旨在研究湖州 HIV 感染者在接受高效抗逆转录病毒治疗（HAART）前后的血脂代谢状况，并探讨不同 HAART 方案对血脂异常的影响。
纳入 2010 年 6 月至 2022 年 6 月在湖州确诊的 PLHIV。收集随访期间的基线特征和临床数据，包括一些血脂指标（总胆固醇和甘油三酯）和 HAART 方案。采用多变量 logistic 回归模型和广义估计方程模型分析治疗方案对血脂异常风险的独立影响。
HAART 后 PLHIV 血脂异常的总体患病率为 70.11%。与接受拉米夫定（3TC）+依非韦伦（EFV）+齐多夫定（AZT）的 PLHIV 相比，接受 3TC+EFV+替诺福韦二吡呋酯（TDF）的 PLHIV 血脂异常的患病率更高。在调整 BMI、年龄、糖尿病状态等重要协变量的 logistic 分析中，我们发现 3TC+EFV+AZT（血脂异常：比值比[OR] = 2.09，95%置信区间[Cl]：1.28-3.41；TG≥1.7：OR = 2.40，95%Cl：1.50-3.84）的血脂异常风险高于 3TC+EFV+TDF。此外，在按 HAART 方案 1:1 匹配的 PLHIV 中，广义估计方程的结果再次表明，与 3TC+EFV+TDF 相比，3TC+EFV+AZT（TG≥1.7：OR = 1.84，95%Cl：1.10-3.07）的 TG 边缘升高风险更高。
血脂异常的患病率因不同的抗逆转录病毒方案而异。通过使用横断和纵向数据，我们从两个角度重复证明 AZT 对血脂的不良影响大于 TDF。因此，我们建议在临床存在并发心血管疾病风险的人群中谨慎使用 3TC+EFV+AZT 方案。
