Stavudine versus zidovudine and the development of lipodystrophy
Stavudine versus zidovudine and the development of lipodystrophy
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DOI：
10.1097/00126334-200107010-00004
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发表时间：
2001-07-01
期刊：
影响因子：
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通讯作者：
Goebel, FD
中科院分区：
文献类型：
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作者：
Bogner, JR;Vielhauer, V;Goebel, FD
脂肪营养不良（LD）综合征的某些组分的发病机制可能与核苷的使用有关。早期的报告没有根据核苷骨架比较治疗方案。我们研究了一组没有在司他夫定和齐多夫定之间转换的个体。如果符合以下三个标准之一，则定义为存在LD：患者的自我报告，自开始高效抗逆转录病毒治疗（HAART）以来认识患者的研究者的观察，或对治疗不知情的医生的检查。平均治疗持续时间为101周（范围：26-234周）。LD的总患病率为48.7%。分别有33.9%和28.7%的患者发生脂肪萎缩和脂肪肥大。Logistic回归分析显示，4个参数与脂肪萎缩显著相关：HAART时间超过2年（p = 0.002，比值比[ORI = 4.4，95%置信区间[CI]：1.608-11.965），基线病毒载量> 100，000拷贝/ml（p = 0.004，OR = 4.3，CI：1.726-11.197），年龄> 40岁（p = 0.016，OR = 3.2，CI：1.247-8.373），和白色种族（p = 0.041，OR = 5.4，CI：1.070-28.184）。基线时胆固醇水平> 200 mg/dl与风险降低相关（p = 0.047，OR = 0.36，CI：0.130-0.987）。使用脂肪肥大作为因变量与HAART持续时间（p = 0.028，OR = 2.7，CI：1.2-6.5）和蛋白酶抑制剂使用（p = 0.014，OR = 3.8，CI：1.3-11.2）显著相关。LD患病率与使用司他夫定或齐多夫定的两种骨架相似。这是首次显示基线胆固醇水平与脂肪萎缩显著相关。
The pathogenesis of some components of the lipodystrophy (LD) syn drome might be linked to the use of nucleosides. Earlier reports did not compare treatment regimens according to the nucleoside backbone. We studied a cohort of individuals who did not switch between stavudine and zidovudine. LD was defined to be present if one of three criteria was met: self-report by the patient, observation by an investigator who had known the patient since commencement of highly active antiretroviral therapy (HAART), or examination by a physician masked to therapy. The mean duration of therapy was 101 weeks (range: 26-234 weeks). Overall prevalence of LD was 48.7%. Lipoatrophy and lipohypertrophy occurred in 33.9% and 28.7% of patients, respectively. Logistic regression showed four parameters to be significantly associated with lipoatrophy: HAART longer than 2 years (p = .002, odds ratio [ORI = 4.4, 95% confidence interval [CI]: 1.608-11.965), baseline viral load > 100,000 copies/ml (p = .004, OR = 4.3, CI: 1.726-11.197), age > 40 years (p = .016, OR = 3.2, CI: 1.247-8.373), and white ethnicity (p = .041, OR = 5.4, CI: 1.070-28.184). Cholesterol levels of > 200 mg/dl at baseline were associated with a risk reduction (p = .047, OR = 0.36, CI: 0.130-0.987). Use of lipohypertrophy as a dependent variable resulted in a significant association with HAART duration (p = 0.028, OR = 2.7, CI: 1.2-6.5) and protease inhibitor use (p = .014, OR = 3.8, CI: 1.3-11.2). LD prevalence is similar with both backbones using stavudine or zidovudine. This is the first time that baseline cholesterol uas shown to be significantly associated with lipoatrophy.