Wenjing Zhai, Fei Ouyang, Shenao Zhan, Yu Huang, Gengfeng Fu, Haitao Yang
Key Laboratory of Environmental Medicine Engineering of Ministry of Education, Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China.
Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China.
Front Cardiovasc Med. 2025 Jun 13;12:1498165. doi: 10.3389/fcvm.2025.1498165. eCollection 2025.
Dyslipidemia, a risk factor of cardiovascular diseases, was a long-term adverse event of anti-retroviral drugs. Efavirenz (EFV) and lopinavir/ritonavir (LPV/r) were recommended and the widely used antiretroviral drugs while the proportion of taking integrase strand transfer inhibitors (INSTI)-based regimens are increasing recently in China. Regarding to the large population of people living with HIV (PLWH) in China and the regional fluctuations in prevalence of dyslipidemia, this meta-analysis aims to evaluate the prevalence of dyslipidemia and its correlation with anti-retroviral therapy (ART) among PLWH in China, especially the impact of LPV/r, EFV and INSTI-based regimens.
We searched English and Chinese databases using MeSH terms to identify all relevant articles. The study participants were divided into ART-naïve and ART-experienced PLWH. The prevalence of dyslipidemia and mean difference of serum lipids were estimated using random-effects models. Subgroup analysis and univariate meta-regression were conducted to evaluate factors associated with prevalence of dyslipidemia among ART-experienced PLWH.
In this meta-analysis, we found dyslipidemia prevalence of 49.8% and 55.1% among ART-naïve and experienced PLWH in China. Elevated triglycerides(TG) and reduced high-density lipoprotein cholesterol (HDL-C) were the most prevalent dyslipidemia, irrespective of ART experience. Dyslipidemia was more common in PLWH residing in South China, with baseline CD4 cell count over 500 cells/μl or with a BMI ≥ 24 kg/m. Notably, Traditional Chinese medicine adjuvant therapy was associated with higher prevalence of dyslipidemia. Moreover, INSTI-based regimens were significantly linked to higher prevalence of low HDL-C compared to other regimens.
The routine assessment of lipid profiles should be advised among PLWH before and after the initiation of ART in China, especially in patients on INSTI-based regiments. Moreover, early interventions, including physical activity, dietary adjustments, and optimization of ART regimens, should be considered when the dyslipidemia is diagnosed in PLWH.
血脂异常是心血管疾病的一个危险因素，是抗逆转录病毒药物的一种长期不良事件。依非韦伦（EFV）和洛匹那韦/利托那韦（LPV/r）是推荐且广泛使用的抗逆转录病毒药物，而在中国，基于整合酶链转移抑制剂（INSTI）的治疗方案的使用比例最近正在增加。鉴于中国大量的艾滋病毒感染者（PLWH）以及血脂异常患病率的地区差异，本荟萃分析旨在评估中国PLWH中血脂异常的患病率及其与抗逆转录病毒治疗（ART）的相关性，尤其是LPV/r、EFV和基于INSTI的治疗方案的影响。
我们使用医学主题词检索英文和中文数据库以识别所有相关文章。研究参与者分为初治和经治的PLWH。使用随机效应模型估计血脂异常的患病率和血脂的平均差异。进行亚组分析和单变量荟萃回归以评估经治PLWH中与血脂异常患病率相关的因素。
在本荟萃分析中，我们发现中国初治和经治PLWH中血脂异常的患病率分别为49.8%和55.1%。无论ART治疗经历如何，甘油三酯（TG）升高和高密度脂蛋白胆固醇（HDL-C）降低是最常见的血脂异常。血脂异常在居住在中国南方、基线CD4细胞计数超过500个细胞/μl或BMI≥24 kg/m²的PLWH中更为常见。值得注意的是，中医辅助治疗与血脂异常的较高患病率相关。此外，与其他治疗方案相比，基于INSTI的治疗方案与低HDL-C的较高患病率显著相关。
在中国，建议在PLWH开始ART治疗之前和之后常规评估血脂谱，尤其是对于接受基于INSTI治疗方案的患者。此外，当PLWH被诊断为血脂异常时，应考虑早期干预，包括体育活动、饮食调整和优化ART治疗方案。
