Weight Change After Antiretroviral Therapy and Mortality
Weight Change After Antiretroviral Therapy and Mortality
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DOI：
10.1093/cid/civ192
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发表时间：
2015-06-15
影响因子：
11.8
通讯作者：
Justice, Amy C.
中科院分区：
文献类型：
--
作者：
Yuh, Bianca;Tate, Janet;Justice, Amy C.
背景抗逆转录病毒治疗（ART）开始后体重增加是常见的，但其对死亡率的影响尚不清楚。我们评估了ART开始后第一年的体重变化及其与随后死亡率的关系。在2000年至2008年期间开始ART的退伍军人老龄队列研究（VACS）中的人类免疫缺陷病毒感染患者，在基线和1年后记录体重，再随访5年的死亡率。基线体重指数（BMI）被归类为体重不足（≥ 30 kg/m2）。我们使用多变量考克斯模型来评估死亡风险，并使用VACS指数对疾病严重程度进行校正。样本包括4184名男性和127名女性，平均年龄为47.9 ± 10.0岁。ART治疗1年后，中位体重变化为5.9磅（2.7 kg）（四分位距，-2.9至17.0磅，-1.3至7.7 kg）。ART开始后体重增加与体重不足和正常体重患者的死亡率降低相关。体重增加10- 19.9磅（4.5 - 9.0 kg）的最低阈值对正常体重患者有益（风险比，0.56; 95%置信区间，0.41 - 0.78），但对超重/肥胖患者体重增加没有明显的益处。基线体重、CD 4细胞计数状态和血红蛋白水平与体重增加密切相关。无论初始体重如何，疾病严重程度越高，体重增加的风险越高。ART开始后体重增加的生存益处取决于起始BMI。ART后体重增加与那些最初不超重的人的死亡率较低有关。
Background. Weight gain after antiretroviral therapy (ART) initiation is common, but its implication for mortality is unknown. We evaluated weight change in the first year after ART initiation and its association with subsequent mortality.Methods. Human immunodeficiency virus-infected patients from the Veterans Aging Cohort Study (VACS) who initiated ART between 2000 and 2008, with weight recorded at baseline and 1 year later, were followed another 5 years for mortality. Baseline body mass index (BMI) was classified as underweight (= 30 kg/m(2)). We used multivariable Cox models to assess mortality risk with adjustment for disease severity using the VACS Index.Results. The sample consisted of 4184 men and 127 women with a mean age of 47.9 +/- 10.0 years. After 1 year of ART, median weight change was 5.9 pounds (2.7 kg) (interquartile range, -2.9 to 17.0 pounds, -1.3 to 7.7 kg). Weight gain after ART initiation was associated with lower mortality among underweight and normal-weight patients. A minimum threshold of 10- to 19.9-pound (4.5 to 9.0 kg) weight gain was beneficial for normal-weight patients (hazard ratio, 0.56; 95% confidence interval, .41-.78), but there was no clear benefit to weight gain for overweight/obese patients. Baseline weight, CD4 cell count status, and hemoglobin level were strongly associated with weight gain. Risk for weight gain was higher among those with greater disease severity, regardless of weight at initiation.Conclusions. The survival benefits of weight gain after ART initiation are dependent on starting BMI. Weight gain after ART is associated with lower mortality for those who are not initially overweight.