Longitudinal changes in serum lipids among HIV-infected men on highly active antiretroviral therapy
Longitudinal changes in serum lipids among HIV-infected men on highly active antiretroviral therapy
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DOI：
10.1111/j.1468-1293.2007.00470.x
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发表时间：
2007-07-01
期刊：
影响因子：
3
通讯作者：
Sharrett, A. R.
中科院分区：
文献类型：
--
作者：
Riddler, S. A.;Li, X.;Sharrett, A. R.
目的研究HIV感染者接受高效抗逆转录病毒治疗(HAART)后血脂的纵向变化，并进行长期随访。方法从多中心艾滋病队列研究(MACS)中筛选出304名在HAART开始前和HAART开始后7年内进行血脂检测的HIV感染者。结果在HAART开始后0.5年内出现明显的血脂变化，而TC(+1.09 mm ol/L)、L DL-C(+0.57 mm o l/L)、HDLc(+0.16 mm o l/L)和非HDLc(+0.91 mm o l/L)在HAART开始2~3年后达到峰值。在随后的几年中，血清总胆固醇、低密度脂蛋白-C和非高密度脂蛋白-C的下降与降脂药物的使用大幅增加(从治疗前的1%增加到治疗后6-7年的43%)同时发生，但在治疗后的2-7年期间，接受过降胆固醇药物治疗或胆固醇水平升高的男性比例(>；5.18 mmol/L)没有变化。HAART开始后2~3年，平均高密度脂蛋白胆固醇也有所下降，55%的HIV感染者在HAART开始后6~7年仍处于较低水平(<；1.04 mmol/L)。结论HAART开始后早期，致动脉粥样硬化的血脂水平升高，在2~3年达到峰值，之后维持在较高水平或需要治疗。大多数男性的高密度脂蛋白胆固醇水平都很低。血脂异常对心血管风险的长期影响，以及长期使用降脂药物与HAART联合使用的有效性和毒性尚不清楚。
ObjectiveThe aim of the study was to describe longitudinal changes in serum lipids among HIV-infected men receiving highly active antiretroviral therapy (HAART) with long-term follow-up.MethodsA total of 304 HIV-infected men who initiated HAART and who had serum lipid measurements prior to and for up to 7 years after HAART initiation were identified from the Multicenter AIDS Cohort Study (MACS). Mean levels of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) were examined at biannual time-points.ResultsSignificant lipid changes were seen within 0.5 years of HAART initiation but increases in TC (+1.09 mmol/L), LDL-C (+0.57 mmol/L), HDL-C (+0.16 mmol/L) and non-HDL-C (+0.91 mmol/L) reached peak levels 2-3 years after HAART initiation. Declines in serum TC, LDL-C and non-HDL-C in subsequent years occurred concurrently with a substantial increase in use of lipid-lowering medications (from 1% usage pre-HAART to 43% 6-7 years after HAART initiation) but the proportion of men who either were treated with cholesterol-lowering medication or had elevated cholesterol levels (> 5.18 mmol/L) did not change during the 2-7-year interval after HAART. Mean HDL-C also decreased after 2-3 years and was low (< 1.04 mmol/L) in 55% of HIV-infected men 6-7 years after HAART initiation.ConclusionsAtherogenic serum lipids increased early after the initiation of HAART, peaked at 2-3 years and remained high or required treatment thereafter. Low HDL-C levels persisted in the majority of men. The long-term effects of lipid abnormalities on cardiovascular risk and the effectiveness and toxicity of prolonged use of lipid-lowering medications in combination with HAART are not known.