High Prevalence of Dyslipidemia and Insulin Resistance in HIV-infected Prepubertal African Children on Antiretroviral Therapy
High Prevalence of Dyslipidemia and Insulin Resistance in HIV-infected Prepubertal African Children on Antiretroviral Therapy
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DOI：
10.1097/inf.0000000000000927
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发表时间：
2016-01-01
影响因子：
3.6
通讯作者：
Browne, Sara H.
中科院分区：
文献类型：
--
作者：
Innes, Steve;Abdullah, Kameelah L.;Browne, Sara H.
背景资料：数据描述的真实程度的抗逆转录病毒治疗（ART）诱导血脂异常和胰岛素抵抗围产期感染的儿童在ART在Africa.Methods：空腹总胆固醇，低密度脂蛋白（LDL），高密度脂蛋白（HDL），甘油三酯，胰岛素和葡萄糖进行了第一次100 190儿科ART诊所参加。由经过培训的营养师进行饮食评估。脂肪萎缩的正式分级是由2名艾滋病儿科专家达成共识。记录既往ART暴露的持续时间、临床分期、ART前病毒载量、最低值和当前CD 4。结果：胰岛素抵抗、总胆固醇、低密度脂蛋白、高密度脂蛋白和甘油三酯异常的发生率分别为10%、13%、12%、13%和9%。总体而言，40%的患者至少有1种血脂异常或胰岛素抵抗。洛匹那韦/r累积暴露每增加一年，校正的平均LDL胆固醇增加0.24 mmol/L（P = 0.03）在校正年龄、性别、体重指数、既往司他夫定暴露、ART开始时的年龄、膳食脂肪和精制碳水化合物后，而在前6个月内暴露于依法韦仑的儿童校正后的平均LDL胆固醇高0.9 mmol/L（P = 0.02）。调整年龄、性别和种族后，双能X线吸收测定法显示，躯干脂肪增加和外周皮下脂肪减少与甘油三酯升高相关，但与总胆固醇、LDL、HDL或稳态模型评估无关。同样，视觉上明显的脂肪萎缩的存在与甘油三酯升高，但不与总胆固醇，低密度脂蛋白，高密度脂蛋白，稳态模型评估或lactate.Conclusions：胰岛素抵抗和血脂异常的患病率高。累积洛匹那韦是血脂异常的独立风险因素，依法韦仑暴露仅具有短暂影响。
Background: Data describing the true extent of antiretroviral therapy (ART)-induced dyslipidemia and insulin resistance in perinatally infected children on ART in Africa are sparse.Methods: Fasting total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides, insulin and glucose were performed on the first 100 of 190 pediatric ART clinic attendees. Diet assessment was performed by a trained dietician. Lipoatrophy was formally graded by consensus between 2 expert HIV pediatricians. Durations of previous ART exposures, clinical stage, pre-ART viral load, nadir and current CD4 were recorded. Dual-energy X-ray absorptiometry was performed on a subset of 42 patients selected semi-randomly.Results: Prevalences of insulin resistance, abnormal total cholesterol, LDL, HDL and triglyceride were 10%, 13%, 12%, 13% and 9%, respectively. Overall, 40% had at least 1 lipid abnormality or insulin resistance. Adjusted mean LDL cholesterol increased by 0.24 mmol/L for each additional year of cumulative lopinavir/r exposure (P = 0.03) after correcting for age, gender, body mass index, previous stavudine exposure, age at ART initiation, dietary fat and refined carbohydrate, whereas adjusted mean LDL cholesterol was 0.9 mmol/L higher in children exposed to efavirenz within the previous 6 months (P = 0.02). Adjusting for age, gender and ethnicity, dual-energy X-ray absorptiometry revealed that greater trunk fat and lower peripheral subcutaneous fat were associated with elevated triglycerides but not with total cholesterol, LDL, HDL or homeostatic model assessment. Similarly, the presence of visually obvious lipoatrophy was associated with elevated triglycerides but not with total cholesterol, LDL, HDL, homeostatic model assessment or lactate.Conclusions: Prevalences of insulin resistance and dyslipidemia were high. Cumulative lopinavir is an independent risk factor for dyslipidemia, with efavirenz exposure having only transitory effect.