Effect of cardio-metabolic risk factors on all-cause mortality among HIV patients on antiretroviral therapy in Malawi: A prospective cohort study
Effect of cardio-metabolic risk factors on all-cause mortality among HIV patients on antiretroviral therapy in Malawi: A prospective cohort study
复制标题
DOI：
10.1371/journal.pone.0210629
复制
发表时间：
2019-01-17
期刊：
影响因子：
3.7
通讯作者：
van Oosterhout, Joep J.
中科院分区：
文献类型：
--
作者：
Amberbir, Alemayehu;Banda, Victor;van Oosterhout, Joep J.
背景 由于持续炎症、高血压和糖尿病合并症、生活方式因素以及接受抗逆转录病毒治疗 (ART)，艾滋病毒感染者的心血管疾病 (CVD) 风险升高。非洲缺乏关于 CVD 风险如何影响 ART 患者发病率和死亡率的数据。我们探讨了 CVD 危险因素和弗雷明汉风险评分 (FRS) 对中期 ART 结局的影响。 方法 2014 年 7 月至 2016 年 12 月，对马拉维松巴区农村和城市 HIV 诊所接受 ART 的患者进行了标准化 ART 结局（ART 死亡、存活、停止 ART、违约和转出）的前瞻性队列研究。主要结果是死亡。未进行主动违约者追踪，转出和违约的患者被排除在分析之外。入组时，诊断高血压、糖尿病和血脂异常，收集生活方式数据并确定 FRS。使用 Cox 回归分析确定死亡结果的独立危险因素。 结果 纳入的 933 名患者中，中位年龄为 42 岁（IQR：35-50），72% 为女性，24% 患有高血压，4% 患有糖尿病，15.8% 总胆固醇升高。中位随访时间为 2.4 年。 20 名患者 (2.1%) 死亡，50 名患者 (5.4%) 违约，63 名患者 (6.8%) 转出，800 名患者 (85.7%) 接受 ART 治疗后存活（城市为 81.7%，农村为 89.9%）。在多变量生存分析中，男性（aHR = 3.28；95% CI：1.33-8.07，p = 0.01）和总/HDL胆固醇比率（aHR = 5.77，95% CI：1.21-27.32；p = 0.03）与死亡率显着相关。死亡率与高血压、体重指数、中心性肥胖、糖尿病、FRS、身体活动不足、入组时吸烟、ART 治疗方案和 WHO 疾病分期之间没有显着相关性。 结论 ART 患者的中期全因死亡率与男性性别和总胆固醇/高密度脂蛋白胆固醇比率升高相关。
BackgroundCardiovascular disease (CVD) risk among people living with HIV is elevated due to persistent inflammation, hypertension and diabetes comorbidity, lifestyle factors and exposure to antiretroviral therapy (ART). Data from Africa on how CVD risk affects morbidity and mortality among ART patients are lacking. We explored the effect of CVD risk factors and the Framingham Risk Score (FRS) on medium-term ART outcomes.MethodsA prospective cohort study of standardized ART outcomes (Dead, Alive on ART, stopped ART, Defaulted and Transferred out) was conducted from July 2014-December 2016 among patients on ART at a rural and an urban HIV clinic in Zomba district, Malawi. The primary outcome was Dead. Active defaulter tracing was not done and patients who transferred out and defaulted were excluded from the analysis. At enrolment, hypertension, diabetes and dyslipidemia were diagnosed, lifestyle data collected and the FRS was determined. Cox-regression analysis was used to determine independent risk factors for the outcome Dead.ResultsOf 933 patients enrolled, median age was 42 years (IQR: 35-50), 72% were female, 24% had hypertension, 4% had diabetes and 15.8% had elevated total cholesterol. The median follow up time was 2.4 years. Twenty (2.1%) patients died, 50 (5.4%) defaulted, 63 (6.8%) transferred out and 800 (85.7%) were alive on ART care (81.7% urban vs. 89.9% rural). In multivariable survival analysis, male gender (aHR = 3.28; 95% CI: 1.33-8.07, p = 0.01) and total/HDL cholesterol ratio (aHR = 5.77, 95% CI: 1.21-27.32; p = 0.03) were significantly associated with mortality. There was no significant association between mortality and hypertension, body mass index, central obesity, diabetes, FRS, physical inactivity, smoking at enrolment, ART regimen and WHO disease stage.ConclusionsMedium-term all-cause mortality among ART patients was associated with male gender and elevated total/HDL cholesterol ratio.