HIV-related wasting in HIV-infected drug users in the era of highly active antiretroviral therapy
HIV-related wasting in HIV-infected drug users in the era of highly active antiretroviral therapy
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DOI：
10.1086/444499
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发表时间：
2005-10-15
影响因子：
11.8
通讯作者：
Baum, MK
中科院分区：
文献类型：
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作者：
Campa, A;Yang, ZF;Baum, MK
背景资料。据报道，在高效抗逆转录病毒疗法(HAART)时代，与人类免疫缺陷病毒(HIV)感染相关的消耗率有所下降。我们在佛罗里达州迈阿密难以接触到的HIV感染吸毒者人群中调查了这一问题。在获得知情同意后，对119名感染艾滋病毒的吸毒者进行了问卷调查，调查内容包括人口统计、病史和食品安全信息。采集血样进行免疫学和病毒研究。HIV相关性消瘦超过6个月定义为身体质量指数为18.5 kg/m(2)，6个月内非故意体重下降10%，或体重达到理想体重的90%。HIV相关消瘦的患病率为17.6%。有过消瘦经历的人(81%)报告说，与没有经历过消瘦的人(57%)相比，他们在上个月有一段时间没有进食(即食物不安全)的比例要高得多。虽然有消瘦经历的患者接受HAART的比例更高，但他们的HIV RNA水平(偏差[SD]，拷贝/毫升；中位数对数HIV RNA水平平均+/-标准166,689+/-238,002+/-SD对数(10)拷贝/毫升)是没有经历过消瘦的患者(72,156+/-10.2+/-2.7平均数+/-SD 149,080；中位数对数HIV RNA对数(10)拷贝/毫升)的两倍多。经历过浪费的参与者是+/-SD 9.2+/-2.3级，更有可能是酗酒者和可卡因使用者。在包括年龄、性别、食品安全、饮酒、可卡因使用、病毒载量和接受抗逆转录病毒治疗在内的多因素分析中，唯一有意义的预测因素是前一个月内1天不吃东西(优势比[OR]，1.96；95%可信区间[CI]，1.18-3.26；P-.01)和病毒载量(OR，1.64；95%CI，1.00-2.69；P=05)。与艾滋病毒有关的浪费在艾滋病毒感染的吸毒者中仍然很常见，甚至在接受HAART的人中也是如此。食物不安全和病毒载量是浪费的唯一独立预测因素。影响感染艾滋病毒吸毒者生活方式的社会和经济条件对预防和治疗浪费构成了挑战。
Background. A decrease in the rate of human immunodeficiency virus (HIV) infection-related wasting has been reported in the era of highly active antiretroviral therapy (HAART). We investigated this concern in a hard-to-reach population of HIV-infected drug users in Miami, Florida.Methods. After informed consent was obtained, 119 HIV-infected drug users were administered questionnaires involving demographic, medical history, and food-security information. Blood samples were drawn for immunological and viral studies. HIV-related wasting over a period of >= 6 months was defined as a body mass index of < 18.5 kg/m(2), unintentional weight loss of >= 10% over 6 months, or a weight of < 90% of the ideal body weight.Results. The prevalence of HIV-related wasting was 17.6%. A significantly higher proportion of those who experienced wasting (81%) reported that there were periods during the previous month when they went for >= 1 day without eating (i.e., food insecurity), compared with those who did not experience wasting (57%). Although a greater percentage of patients who experienced wasting were receiving HAART, their HIV RNA levels were more than twice as high (deviation [SD], copies/mL; median log HIV RNA level mean +/- standard 166,689 +/- 238,002 +/- SD log(10) copies/mL) as those for the group that did not experience wasting (, 72,156 +/- 10.2 +/- 2.7 mean +/- SD 149,080; median log HIV RNA log(10) copies/mL). Participants who experienced wasting were level +/- SD 9.2 +/- 2.3 more likely to be heavy alcohol drinkers and users of cocaine. In multivariate analysis that included age, sex, food security, alcohol use, cocaine use, viral load, and receipt of antiretroviral therapy, the only significant predictors of wasting were >= 1 day without eating during the previous month (odds ratio [OR], 1.96; 95% confidence interval [CI], 1.18-3.26; P - .01) and viral load (OR, 1.64; 95% CI, 1.00-2.69; P = 05).Conclusions. HIV-related wasting continues to be common among HIV- infected drug users, even among HAART recipients. Food insecurity and viral load were the only independent predictors of wasting. The social and economic conditions affecting the lifestyle of HIV-infected drug users constitute a challenge for prevention and treatment of wasting.