Changes in blood pressure, glucose levels, insulin secretion and anthropometry after long term exposure to antiretroviral therapy in South African women
Changes in blood pressure, glucose levels, insulin secretion and anthropometry after long term exposure to antiretroviral therapy in South African women
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DOI：
10.1186/s12981-015-0065-8
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发表时间：
2015-08-05
影响因子：
2.2
通讯作者：
Levitt, Naomi S.
中科院分区：
文献类型：
--
作者：
Abrahams, Zulfa;Dave, Joel A.;Levitt, Naomi S.
背景：许多代谢异常，例如血糖异常、胰岛素抵抗、脂肪营养不良和血脂异常，都与抗逆转录病毒药物的使用有关。我们的目的是评估长期抗逆转录病毒暴露对南非黑人女性血压、血糖、胰岛素分泌和人体测量指标的影响。方法：对基线时接受一线 ART 治疗时间中位数为 16 个月的 HIV 感染女性进行方便样本，在基线时和大约 5 年后进行两次以下评估：人体测量，包括皮褶厚度、血压、口服葡萄糖测试和胰岛素。估计胰岛素敏感性和分泌（HOMA-IR、IGI 和 DIo）。结果：在基线时，超过一半的 103 名女性正在使用司他夫定和依非韦伦。基线和随访评估之间的中位间隔为 66 个月。体重、腰围和腰臀比随着时间的推移而增加，而四肢皮褶厚度随着时间的推移而减少。收缩压和舒张压显着升高，患有高血压的参与者比例从 3.9% 增加至 15.5% (p < 0.001)。 30 分钟和 120 分钟时血浆葡萄糖浓度较基线有所增加； 0 和 30 分钟时的胰岛素浓度；以及 IGI 和 DIo。患有糖尿病的参与者比例从 1% 增加到 7.5% (p = 0.070)。结论：在长期接受 ART 的南非黑人女性中，观察到高血压和可能的糖尿病的增加。参与者的中心脂肪增加，周围脂肪分布减少。及早识别和管理这些代谢变化非常重要，尤其是在世界上艾滋病毒感染人口最多的地区。
Background: A number of metabolic abnormalities, such as dysglycaemia, insulin resistance, lipodystrophy and dyslipidaemia, are associated with the use of antiretroviral drugs. We aimed to assess the effects of long-term antiretroviral exposure on blood pressure, glycaemia, insulin secretion and anthropometric measures in black South African women.Methods: A convenience sample of HIV-infected women on first-line ART for a median of 16 months at baseline, had the following evaluations twice, at baseline and after approximately 5 years: anthropometry, including skin fold thicknesses, blood pressure, oral glucose test, and insulin. Insulin sensitivity and secretion (HOMA-IR, IGI and DIo) were estimated.Results: At baseline more than half the 103 women were using stavudine and efavirenz. The median interval between baseline and follow-up evaluation was 66 months. Weight, waist circumference, and waist-hip ratio increased over time, while limb skinfold thickness decreased over time. Systolic and diastolic blood pressure increased significantly and the proportion of participants with hypertension increased from 3.9 to 15.5% (p < 0.001). There were increases from baseline in plasma glucose concentrations at 30 and 120 min; insulin concentrations at 0 and 30 min; and IGI and DIo. The proportion of participants with diabetes increased from 1 to 7.5% (p = 0.070).Conclusion: In black South African women with long-term exposure to ART, increases in hypertension and possibly diabetes were observed. Participants experienced an increase in central fat and a decrease in peripheral fat distribution. Early identification and management of these metabolic changes are important, especially in a region with the highest HIV-infected population in the world.