Impact of HIV infection and HAART on serum lipids in men
Impact of HIV infection and HAART on serum lipids in men
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DOI：
10.1001/jama.289.22.2978
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发表时间：
2003-06-11
影响因子：
120.7
通讯作者：
Kingsley, LA
中科院分区：
文献类型：
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作者：
Riddler, SA;Smit, E;Kingsley, LA
背景广泛报道了接受高效抗逆转录病毒治疗（HAART）的1型人类免疫缺陷病毒（HIV）感染者的血脂值变化，但尚未报道转阳前血脂值变化的数据。目的描述与HIV感染和抗逆转录病毒药物暴露相关的血清胆固醇水平变化，设计、设置和参与者多中心AIDS队列研究，一项前瞻性研究，其中同性恋和双性恋男性被招募，并且从517名HIV血清转换者中抽取50名用于本文的分析，这些人后来开始HAART，主要指标在平均12年的6个时间点总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）和低密度脂蛋白胆固醇（LDL-C）水平的变化;从HAART后第三次门诊访视开始对甘油三酯水平进行1次评估。HIV感染后，观察到平均血清TC（-30 mg/dL [-0.78 mmol/L]）、HDL-C（-12 mg/dL [-0.31 mmol/L]）和LDL-C值（-22 mg/dL [-0.57 mmol/L]）显著下降。HAART开始后，平均TC和LDL-C值大幅增加（50和21 mg/dL [1.30和0.54 mmol/L]）;然而，与转换前值相比的平均变化为20 mg/dL（0.52 mmol/L）（95%置信区间[CI]，-1至41）和-1 mg/dL（-0.03 mmol/L）（95% CI，-25至22）。在整个随访期间，平均HDL-C保持低于基线水平。甘油三酯的中位数（四分位数范围）为225 mg/dL（2.54 mmol/L）（147-331 mg/dL）。结论治疗前，HIV感染导致血清TC、HDL-C和LDL-C水平显著降低。随后开始HAART治疗与TC和LDL-C升高相关，但HDL-C变化不大。HAART治疗约3年后观察到的TC和LDL-C升高可能代表在考虑预期的年龄相关变化后恢复至感染前血脂水平。
Context Alterations in serum lipid values have been widely reported among persons infected with human immunodeficiency virus (HIV) type 1 treated with highly active antiretroviral therapy (HAART), but no data have yet been reported on changes from preseroconversion lipid values.Objective To describe changes in serum cholesterol levels associated with HIV infection and antiretroviral medication exposure, and 1-time assessment of triglyceride levels post-HAART initiation.Design, Setting, and Participants The Multicenter AIDS Cohort Study, a prospective study in which homosexual and bisexual men were enrolled and from which 50 of 517 HIV seroconverters were drawn for the analysis herein, who later initiated HAART, involving measurements of stored serum samples obtained between 1984 and 2002.Main Outcome Measures Changes in levels of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) at 6 time points during an average of 12 years; 1-time assessment of triglyceride levels from the third post-HAART clinic visit.Results Among the 50 men, notable declines in mean serum TC (-30 mg/dL [-0.78 mmol/L]) HDL-C (-12 mg/dL [-0.31 mmol/L]), and LDL-C values (-22 mg/dL [-0.57 mmol/L]) were observed after HIV infection. Following HAART initiation, there were large increases in mean TC and LDL-C values (50 and 21 mg/dL [1.30 and 0.54 mmol/L], respectively); however, the mean changes from the preseroconversion values were 20 mg/dL (0.52 mmol/L) (95% confidence interval [CI], -1 to 41) and -1 mg/dL (-0.03 mmol/L) (95% Cl, -25 to 22), respectively. Mean HDL-C remained below baseline levels throughout follow-up. The median value (interquartile range) of triglycerides was 225 mg/dL (2.54 mmol/L) (147-331 mg/dL).Conclusions Before treatment, HIV infection results in substantial decreases in serum TC, HDL-C, and LDL-C levels. Subsequent HAART initiation is associated with increases in TC and LDL-C but little change in HDL-C. Increases in TC and LDL-C observed after about 3 years of HAART possibly represent a return to preinfection serum lipid levels after accounting for expected age-related changes.