摘要
目的探讨联合抗病毒治疗(combination antiretroviral therapy,cART)对人类免疫缺陷病毒感染者(people living with human immunodeficiency virus,PLWH)血脂和心血管疾病风险的影响,分析高脂血症发生的危险因素。方法采用回顾性队列研究方法,选择2018年6月至2020年1月在河南省传染病医院感染与免疫门诊初治PLWH为研究对象,收集PLWH基线、cART 1年、3年和5年血脂、血压、人类免疫缺陷病毒载量和CD4^(+)T细胞水平以及糖尿病发生情况,使用Framingham评分评价10年心血管疾病风险,采用单因素和多因素分析PLWH发生高脂血症的危险因素。结果共纳入318例PLWH,其中男性289例(90.88%);年龄35(29,46)岁。PLWH在cART后血脂变化表现为高脂血症发生率升高和低高密度脂蛋白血症发生率下降。高脂血症发生率由启动cART时23.58%升至cART 5年时35.53%,以高甘油三酯血症发生率升高为主,其中非核苷类反转录酶抑制剂和蛋白酶抑制剂方案在cART 1年时变化显著(P均<0.017),高总胆固醇血症和高低密度脂蛋白血症发生率无明显变化(P均>0.017)。低高密度脂蛋白血症发生率由启动治疗时45.28%降至cART 5年时11.32%,cART 1年时变化明显P均<0.05。多因素分析结果显示,吸烟、体质量指数>25 kg/m2和使用替诺福韦+拉米夫定+洛匹那韦利托那韦方案是发生高脂血症的危险因素(P均<0.05)。Framingham评分未发现cART 5年对PLWH 10年心血管疾病风险有明显变化。结论PLWH在cART 5年中血脂变化主要表现为高甘油三酯血症发生率升高和低高密度脂蛋白血症发生率下降,在cART 1年时变化显著。吸烟、体质量指数>25 kg/m2和使用替诺福韦+拉米夫定+洛匹那韦利托那韦方案人群容易发生高脂血症,应加强血脂监测。cART 5年对PLWH 10年心血管疾病风险无明显影响。
Objective To investigate the effects of people living with human immunodeficiency virus(PLWH)combined with combination antiretroviral therapy(cART)on the risk of blood lipids and cardiovascular diseases,and to analyse the risk factors for hyperlipidaemia.Methods retrospective cohort study was conducted,selecting newly treated PLWH patients in the Infection and Immunity Clinic of Henan Provincial Infectious Disease Hospital from June 2018 to January 2020.Data on serum lipids,blood pressure,diabetes mellitus,HIV load,and CD4^(+)T cell levels were collected at baseline,and after 1,3,and 5 years of cART,respectively.The 10-year CVD risk was evaluated using the Framingham score,and the risk factors for hyperlipidaemia in PLWH were analysed by univariate and multivariate analysis.Results A total of 318 cases of PLWH were enrolled,including 289 males(90.88%).Age 35(29,46)years.The changes in blood lipids after cART in PLWH showed an increase in the incidence of hyperlipidemia and a decrease in the incidence of low high-density lipoprotein cholesterol(HDL-C).The incidence of hypertriglyceridemia increased from 23.58%at the initiation of treatment to 35.53%at 5 years of cART,with hypertriglyceridemia(TG)being the main contributor to the increase,and the non-nucleoside reverse transcriptase inhibitor and protease inhibitor regimens changed significantly at 1 year of cART(P<0.017).There was no significant change in the incidence of hypercholesterolemia and ow-density lipoprotein cholesterol(P>0.017).The incidence of low HDL-C decreased from 45.28%at the initiation of treatment to 11.32%at 5 years of cART,and the change in the incidence at 1 year of cART was significant(P<0.05).The results of multivariate analysis showed that smoking,body mass index>25 kg/m2,and tenofovir lamivudine and lopinavir ritonavir regimens were risk factors for the development of hyperlipidemia(P<0.05).The Framingham score did not show a significant change in the 10-year cardiovascular risk of PLWH during 5 years with cART.Conclusions The changes in blood lipids in PLWH during the 5-year cART were mainly manifested by the increase in the incidence of hypertriglyceridemia and the decrease in the incidence of low HDL-C,which changed significantly at 1 year of cART.Individuals who smoke,have a body mass index greater than 25 kg/m2,and use enofovir+lamivudine+lopinavir/ritonavir regimens are prone to hyperlipidemia and should be monitored for lipids.Five years of cART had no significant effect on the 10-year risk of cardiovascular disease in PLWH.
作者
夏玉朝
杨萱
甘源
张晓华
李琼
王雪婷
XIA Yuchao;YANG Xuan;GAN Yuan;ZHANG Xiaohua;LI Qiong;WANG Xueting(Pharmacy Department,The Affiliated Infectious Diseases Hospital of Zhengzhou University(Henan Provincial Infectious Diseases Hospital),450000,China)
出处
《传染病信息》
2025年第4期342-346,共5页
Infectious Disease Information
基金
河南省科技攻关课题(232102311081)。
关键词
人类免疫缺陷病毒感染者
血脂代谢
心血管疾病风险
危险因素
联合抗病毒治疗
people living with human immunodeficiency virus
lipid metabolism
cardiovascular disease risk
risk factors
combined antiviral therapy
