Cardiovascular disease risk factors in HIV-infected women after initiation of lopinavir/ritonavir- and nevirapine-based antiretroviral therapy in Sub-Saharan Africa: A5208 (OCTANE).
Cardiovascular disease risk factors in HIV-infected women after initiation of lopinavir/ritonavir- and nevirapine-based antiretroviral therapy in Sub-Saharan Africa: A5208 (OCTANE).
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DOI：
10.1097/qai.0000000000000131
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发表时间：
2014-06-01
期刊：
影响因子：
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通讯作者：
Currier J
中科院分区：
文献类型：
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作者：
Shaffer D;Hughes MD;Sawe F;Bao Y;Moses A;Hogg E;Lockman S;Currier J
关于非洲开始抗逆转录病毒治疗的艾滋病毒感染妇女的心血管风险因素，存在有限的比较性、前瞻性数据。在7个非洲国家，741名CD 4 <200个细胞/mm 3的妇女被随机分配到替诺福韦/恩曲他滨（TDF/FTC）加奈韦拉平（NVP，n=370）或洛匹那韦/利托那韦（LPV/r，n=371）。在入组、48、96和144周时评价血脂和血压（BP）。多变量线性和逻辑回归模型用于评估平均风险因素变化和临床相关风险因素变化。入组时，NVP和LPV/r组的年龄（平均值=33.5 [SD=7.1]岁）、CD 4（129 [67]个细胞/mm 3）和HIV-1 RNA（5.1 [0.6] log 10拷贝/ml）相似。几乎所有的女性血脂和血压正常，除了HDL。在144周内，LPV/r组与NVP组相比，平均脂质升高显著更大（例如，非HDL：+29 vs. +13 mg/dL），HDL升高较小（+12 vs. +21 mg/dL）。相比之下，NVP组的血压平均升高幅度大于LPV/r组（例如，舒张压：+5 vs-0.5 mmHg）。显著更多分配LPV/r的女性在第144周出现“异常”脂质水平（例如HDL 29.7% vs. 14.8%和甘油三酯28.6% vs. 8.2%），显著更多分配NVP的女性出现“异常”血压（例如舒张压22.7% vs. 6.5%）。当校正基线风险因素、年龄、CD 4和HIV-1 RNA时，大多数差异仍然显著。在非洲开始ART的HIV感染女性中，LPV/r+TDF/FTC与血脂的不利变化相关，使用NVP+TDF/FTC与血压的不利变化相关。
Limited comparative, prospective data exist regarding cardiovascular risk factors in HIV-infected women starting antiretroviral therapy (ART) in Africa. In 7 African countries, 741 women with CD4<200 cells/mm3 were randomized to tenofovir/emtricitabine (TDF/FTC) plus either nevirapine (NVP, n=370) or lopinavir/ritonavir (LPV/r, n=371). Lipids and blood pressure (BP) were evaluated at entry, 48, 96, and 144 weeks. Multivariable linear and logistic regression models were used to evaluate mean risk factor changes and clinically relevant risk factor changes. At entry, both NVP and LPV/r groups were similar regarding age (mean=33.5 [SD=7.1] yrs), CD4 (129 [67] cells/mm3), and HIV-1 RNA (5.1 [0.6] log10 copies/ml). Nearly all women had normal lipids and BP except for HDL. Over 144 weeks, the LPV/r compared to NVP group had significantly greater mean lipid increases (e.g. non-HDL: +29 vs. +13 mg/dL) and smaller HDL increases (+12 vs. +21 mg/dL). In contrast, the NVP compared to LPV/r group had greater mean increases in BP (e.g. diastolic BP: +5 vs. −0.5 mmHg). Significantly more women assigned LPV/r had week 144 “abnormal” lipid levels (e.g. HDL 29.7% vs. 14.8% and triglycerides 28.6% vs. 8.2%), and significantly more women assigned NVP had “abnormal” BP (e.g. diastolic BP 22.7% vs. 6.5%). Most differences remained significant when adjusted for baseline risk factor, age, CD4, and HIV-1 RNA. In HIV-infected women initiating ART in Africa, LPV/r+TDF/FTC was associated with less favorable changes in lipids, and use of NVP+TDF/FTC was associated with less favorable changes in BP.