Prevalence of low high-density lipoprotein among young adults receiving antiretroviral therapy in Zambia: An opportunity to consider non-communicable diseases in resource-limited settings.
Prevalence of low high-density lipoprotein among young adults receiving antiretroviral therapy in Zambia: An opportunity to consider non-communicable diseases in resource-limited settings.
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DOI：
10.1371/journal.pone.0247004
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发表时间：
2021
期刊：
影响因子：
3.7
通讯作者：
Heimburger DC
中科院分区：
文献类型：
--
作者：
Hamooya BM;Musonda P;Mutale W;Masenga SK;Halwiindi H;Mutengo KH;Chiyeñu KOR;Chongwe G;Koethe JR;Lipworth L;Heimburger DC
随着有效的抗逆转录病毒疗法 (ART) 的引入，艾滋病毒感染者 (PLWH) 的生存时间更长，并且面临出现导致心血管疾病 (CVD) 的代谢异常的风险。在撒哈拉以南非洲 (SSA)，接受抗逆转录病毒疗法的年轻人血脂状况的流行病学数据很少。本研究旨在评估赞比亚利文斯顿接受抗逆转录病毒疗法的成年人中低高密度脂蛋白胆固醇 (HDL-c)（一种心脏保护性脂质类别）的患病率，以及该患病率是否因年龄而异。 2019 年 4 月至 12 月，我们对 597 名感染者进行了一项横断面研究 [n = 58，年龄 18-24 岁（年轻人）； n = 539 名年龄≥25 岁（成人）]接受 ART ≥6 个月。收集的数据包括人口统计和生活方式信息、人体测量学、病毒载量 (VL)、CD4 计数、血压、血脂和空腹/随机血糖。临床指标定义为：低HDL-c[男性<1.0 mmol/L，女性<1.3]，腰围增加（WC）[男性≥94 cm，女性≥80 cm]，高甘油三酯（TG）[≥1.7 mmol/l]和病毒学失败（VF）[VL ≥1000拷贝/μl]。在调整多个变量后，我们使用逻辑回归来检查年龄和低 HDL-c 之间的关联。在年轻人中，60% (35/58) 是女性，中位年龄（25%、75%）为 21 岁 (18, 23)，接受 ART 的中位时间为 116 个月 (60, 144)。在成年人中，63% (342/539) 是女性，中位年龄 46 岁 (40, 53)，接受 ART 的中位时间为 108 个月 (60, 144)。与成人相比，年轻人的 CD4 计数较低（中位数为 492 个细胞/μL vs. 568 个细胞/μL，p = 0.010），并且 VF 患病率较高（29% vs. 17%，p = 0.016）。在年轻人中，低 HDL-c 的患病率显着高于成人（63% vs. 38%，p<0.001）。高密度脂蛋白胆固醇 (HDL-c) 水平较低的年轻人 (75%) 和成人 (58%) 中很大比例正在接受基于多替拉韦 (DTG) 的 ART 治疗方案。在调整性别、ART持续时间、WC、体重指数、ART治疗方案、VF、CD4计数、低密度脂蛋白胆固醇、血压和吸烟后，年轻人比成年人更有可能出现低HDL-c（比值比2.93；95%置信区间1.46-5.86）。低 HDL-c 在 SSA 感染 HIV 的年轻人中非常普遍，与代谢紊乱的其他危险因素无关。年轻感染者的脂质异常可能导致该人群心血管疾病的早期发展。这凸显了在 SSA 接受 ART 的年轻人寻求降低 CVD 风险时需要考虑低 HDL-c。
With the introduction of effective antiretroviral therapy (ART), people living with HIV (PLWH) are surviving longer and are at risk for developing metabolic abnormalities that contribute to cardiovascular disease (CVD). In Sub-Saharan Africa (SSA), there is a paucity of epidemiological data on lipid profiles among young adults receiving ART. This study aimed to estimate the prevalence of low high-density lipoprotein cholesterol (HDL-c), a cardioprotective lipid class, and whether it differed by age among adults on ART in Livingstone, Zambia. From April to December 2019, we conducted a cross-sectional study of 597 PLWH [n = 58 aged 18–24 years (young adults); n = 539 aged ≥25 years (adults)] on ART for ≥6 months. Data collected included demographic and lifestyle information, anthropometrics, viral load (VL), CD4 count, blood pressure, lipid profiles and fasting/random blood glucose. Clinical measures were defined as: low HDL-c [<1.0 mmol/L for men, <1.3 for women], increased waist circumference (WC) [≥94 cm for men, ≥80 cm for women], high triglycerides (TG) [≥1.7 mmol/l], and virological failure (VF) [VL ≥1000 copies/μl]. We used logistic regression to examine the association between age and low HDL-c after adjusting for multiple variables. Among the young adults, 60% (35/58) were women, median (25th, 75th percentile) age 21 years (18, 23), and median time on ART 116 months (60, 144). Among adults, 63% (342/539) were women, median age 46 years (40, 53) and median time on ART 108 months (60, 144). Young adults had a lower CD4 count compared to adults (median, 492 vs. 568 cells/μL, p = 0.010) and higher prevalence of VF (29% vs. 17%, p = 0.016). In young adults, prevalence of low HDL-c was significantly higher than in adults (63 vs. 38%, p<0.001). A high proportion of young adults (75%) and adults (58%) with low HDL-c were on dolutegravir (DTG)-based ART regimens. After adjusting for sex, duration on ART, WC, body mass index, ART regimen, VF, CD4 count, low density lipoprotein cholesterol, blood pressure and smoking, young adults were significantly more likely than adults to have low HDL-c (odds ratio 2.93; 95% confidence interval 1.46–5.86). Low HDL-c is highly prevalent among young adult with HIV in SSA independent of other risk factors for metabolic derangements. Lipid abnormalities among young PLWH may contribute to the early development of cardiovascular diseases in this population. This highlights the need to consider low HDL-c in the quest to reduce CVD risk among young adults on ART in SSA.
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影响因子：
158.5
作者：
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DOI：
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发表时间：
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影响因子：
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作者：
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通讯作者：
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影响因子：
37.8
作者：
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DOI：
10.2174/1874091x01206010078
发表时间：
2012
期刊：
The open biochemistry journal
影响因子：
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