Increase in body cell mass and decrease in wasting are associated with increasing potency of antiretroviral therapy for HIV infection
Increase in body cell mass and decrease in wasting are associated with increasing potency of antiretroviral therapy for HIV infection
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DOI：
10.1089/apc.2005.19.216
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发表时间：
2005-04-01
影响因子：
4.9
通讯作者：
McElhiney, M
中科院分区：
文献类型：
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作者：
Ferrando, SJ;Rabkin, JG;McElhiney, M
随着强效抗逆转录病毒联合疗法（ART）的出现，消瘦的发生率有所降低。然而，很少有研究调查与这些治疗相关的特定身体成分变化。本研究的目的是纵向调查日益强大的ART与体细胞质量变化和利用生物电阻抗分析（BIA）的浪费的关联。在这项纵向队列研究中，159例HIV阳性男性从1995年至1997年每半年进行一次评估，利用BIA，CD 4淋巴细胞计数，HIV病毒载量，医疗和抑郁症状的身体组成。消瘦定义为基于HIV阳性标准的体细胞质量/身高低于第90百分位数。使用已发表的临床指南对每次访视时的ART效力进行评分，范围为1（0 - 1种抗逆转录病毒药物）至5（3种或更多种抗逆转录病毒药物，包括强效蛋白酶抑制剂）。未使用病毒耐药性检测。混合效应模型和广义估计方程的方法被用来确定纵向相关的体细胞质量和浪费，分别。在2年的随访中，有效的联合ART使用从6%增加到79%。同时，观察到平均体细胞质量显著增加，消瘦患病率降低，而总体重、脂肪量和总体内水分没有变化。越来越有效的ART与体细胞质量的显着增加和减少浪费有关。其他与体细胞数量增加相关的重要因素包括CD 4计数增加和HIV相关症状、疲劳和抑郁的严重程度降低。目前的研究发现，在相对较短的时间内（2年）服用更高效力的ART与体细胞质量的增加和浪费的减少有关，这些变化与医学（CD 4，HIV症状）和行为（疲劳，抑郁）的改善有关。一个警告是，这项研究没有区分有效的ART方案的类型。鉴于只有一些抗逆转录病毒药物似乎与许多身体成分变化有关，无论其对病毒载量的影响如何，可能是所使用的方案类型解释了病毒载量和身体成分变化之间的关系。
With the advent of potent combination antiretroviral therapy ( ART), there has been a reduction in the incidence of wasting. However, few studies have investigated specific body composition changes associated with these treatments. This study aimed to investigate longitudinally the association of increasingly potent ART with changes in body cell mass and wasting utilizing bioelectric impedance analysis (BIA). In this longitudinal cohort study, 159 HIV-positive men were assessed semiannually from 1995 to 1997 for body composition utilizing BIA, CD4 lymphocyte count, HIV viral load, medical and depressive symptoms. Wasting was defined as body cell mass/height below the 90th percentile based on HIV-positive norms. ART potency at each visit was scored utilizing published clinical guidelines, ranging from 1 ( 0 - 1 antiretrovirals) to 5 ( 3 or more antiretrovirals including a potent protease inhibitor). Viral resistance testing was not used. The mixed-effects model and the generalized estimating equations approaches were used to determine longitudinal correlates of body cell mass and of wasting, respectively. Over the 2 years of follow-up, potent combination ART use increased from 6% to 79%. Concurrently, a significant increase in mean body cell mass and a reduction in prevalence of wasting were seen, while total body weight, fat mass, and total body water did not change. Increasingly potent ART was associated with significant increases in body cell mass and reduction in wasting. Other significant correlates of increased body cell mass included higher CD4 count and decreased severity of HIV-related symptoms, fatigue and depression. The current study found that higher potency ART taken for relatively short term ( 2 years) was associated with an increase in body cell mass and a reduction in wasting and that these changes were associated with both medical ( CD4, HIV symptoms) and behavioral ( fatigue, depression) improvements. One caveat is this study did not distinguish among types of potent ART regimens. Given only some antiretrovirals appear linked to many body composition changes, regardless of their effect on viral load, it may be the type of regimen used that accounted for the relationship seen between viral load and body composition changes.