以依非韦伦为基础的抗病毒治疗方案对成人人类免疫缺陷病毒感染者血脂影响的临床研究

Effect of efavirenz-based antiretroviral regimen on blood lipids: a retrospective clinical study in adult HIV-infected patients

目的了解以依非韦伦(EFV)为基础的初始抗反转录病毒治疗(ART)方案对成人人类免疫缺陷病毒(HIV)感染者血脂的影响。方法回顾性收集重庆市公共卫生医疗救治中心2016年1-6月初次接受含EFVART方案的HIV感染者临床资料,对比分析治疗前及治疗后不同时间点血清总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)以及TC/HDL比值的变化。结果HIV感染者ART前、治疗1年、治疗2年时血脂异常率分别为61.4%、61.5%、63.7%,虽总体异常发生率无明显变化(P>0.05),但随着治疗时间延长,LDL异常率逐渐升高,HDL异常率逐渐下降(P均<0.05)。LDL检测值亦从治疗前的(2.44±0.68)mmol/L升高到治疗1年时(2.89±0.79)mmol/L,2年时(3.20±0.84)mmol/L,差异有统计学意义(P<0.05)。年龄>40岁患者ART2年时TC、LDL升高程度较18~40岁的患者明显(P均<0.05),体重指数≥24患者TG、LDL升高程度较体重正常的患者明显,但差异无统计学意义(P>0.05)。结论以EFV为基础的初始ART治疗方案对患者血脂代谢有明显影响,主要体现在LDL,其异常发生率及其检测值均随治疗时间的延长明显升高。

Objective To investigate the effect of efavirenz-based initial antiretroviral therapy (ART) on serum lipids in adults with HIV infection.Methods The clinical data were collected retrospectively from the HIV-infected patients who received efavirenzbased ART for the first time between January 2016 and June 2016 in Chongqing Public Health Medical Center.Serum levels of total cholesterol (TC),triglyceride (TG),low density lipoprotein (LDL),high density lipoprotein (HDL) and TC/HDL ratio were compared before and after efavirenz-based ART.Results The prevalence of dyslipidemia was 61.4% before ART,61.5% after 1-year ART, and and 63.7% after 2-year ART in HIV-infected patients.No significant change was found in the overall incidence of dyslipidemia (P>0.05).However,the prevalence of abnormal LDL level increased and the prevalence of abnormal HDL level decreased gradually with the duration of efavirenz-based ART (both P<0.05).Mean LDL level increased significantly from (2.44±0.68) mmol/L before ART to (2.89±0.79) mmol/L one year after ART,and (3.20±0.84) mmol/L two years after ART (both P<0.05). After ART for 2 years,serum levels of TC and LDL increased more significantly in the older patients (>40 years) than in younger patients (18-40 years old)(P<0.05).The serum levels of TG and LDL were numerically higher in the heavier patients (BMI≥24) than in the patients with normal body weight (BMI <24)(P >0.05).Conclusions Initial efavirenz-based ART regimen has significant effect on blood lipid profile,which is mainly reflected in LDL.The prevalence of abnormal LDL level and mean value increase significantly with the duration of efavirenzbased ART.