Metabolic syndrome before and after initiation of antiretroviral therapy in treatment-naive HIV-infected individuals.
Metabolic syndrome before and after initiation of antiretroviral therapy in treatment-naive HIV-infected individuals.
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DOI：
10.1097/qai.0b013e3182690e3c
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发表时间：
2012-11-01
期刊：
影响因子：
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通讯作者：
Jacobson DL
中科院分区：
文献类型：
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作者：
Krishnan S;Schouten JT;Atkinson B;Brown T;Wohl D;McComsey GA;Glesby MJ;Shikuma C;Haubrich R;Tebas P;Campbell TB;Jacobson DL
代谢综合征(METS)是心血管疾病和糖尿病的一系列危险因素，其中许多与艾滋病毒和抗逆转录病毒治疗(ART)有关。我们检查了甲型肝炎的患病率和发病率，以及在开始抗逆转录病毒治疗的幼稚HIV感染者中甲型肝炎的危险因素。由成人治疗小组III标准定义的MET在参加选定的艾滋病临床试验组(ACTG)试验的HIV感染者开始抗逆转录病毒治疗时和之后进行评估，并在这些试验结束后作为ACTG纵向链接随机试验队列的一部分进行长期跟踪。采用COX比例风险模型分析METs发病的危险因素。报告了调整后的危险比(AHR)和95%的可信区间(CI)。在ART开始时，METS的患病率为20%。接受抗逆转录病毒治疗后，METs的发病率为8.5/100人年。在调整了人口统计学和体重指数后，CD4+T细胞计数和50个/mm3的METS风险降低(AHR=0.62，95%CI=0.43至0.90)，而HIV-1RNA和GT；400拷贝/毫升的风险增加(AHR=1.55(95%CI=1.25至1.92))和使用基于蛋白酶抑制剂(PI)的方案(相对于不使用PI，对于任何PI使用，AHR=1.25(95%CI=1.04至1.51))。在接受抗逆转录病毒治疗的HIV感染者中，病毒学抑制和维持高的CD4+T细胞计数可能是潜在的可改变的因素，可以降低患METS的风险。蛋氨酸对心血管疾病和糖尿病风险的影响需要评估。
Metabolic syndrome (MetS) is a cluster of risk factors for cardiovascular disease and diabetes, many of which are associated with HIV and antiretroviral therapy (ART). We examined prevalence and incidence of MetS, and risk factors for MetS in ART-naïve HIV-infected individuals starting ART. MetS, defined by the Adult Treatment Panel III criteria, was assessed at and after ART initiation in HIV-infected individuals who enrolled in selected AIDS Clinical Trials Group (ACTG) trials and were followed long-term after these trials as part of the ACTG Longitudinal Linked Randomized Trials cohort. Cox proportional hazards models were used to examine risk factors of incident MetS. Adjusted hazard ratios (aHR) and 95% confidence intervals (CI) are reported. At ART initiation, the prevalence of MetS was 20%. After ART initiation, the incidence of MetS was 8.5 per 100 person-years. After adjusting for demographics and body mass index, the risk of MetS was decreased for CD4+ T-cell counts>50 cells/mm3 (aHR = 0.62, 95% CI=0.43 to 0.90 for CD4>500), and the risk was increased for HIV-1 RNA >400 copies/mL (aHR=1.55 (95% CI=1.25 to 1.92) and use of a protease-inhibitor (PI) based regimen (relative to no PI use, aHR=1.25 (95% CI=1.04 to 1.51) for any PI use). In HIV-infected individuals on ART, virologic suppression and maintenance of high CD4+ T-cell counts may be potentially modifiable factors that can reduce the risk of MetS. The effect of MetS on the risk of cardiovascular disease and diabetes needs to be evaluated.