未启动抗反转录病毒治疗的人类免疫缺陷病毒/艾滋病患者发生心血管疾病的风险评估

Evaluation of risk factors of cardiovascular diseases in anti-retroviral treatment naive human immunodeficiency virus/acquired immunodeficiency syndrome patients

目的分析调查未启动抗反转录病毒治疗(anti-retroviral therapy,ART)的人类免疫缺陷病毒/艾滋病(human immunodeficiency virus/acquired immunodeficiency syndrome,HIV/AIDS)患者发生心血管疾病(cardiovascular diseases,CVD)的风险因素,为患者后续ART方案选择,以及CVD的监测和管理提供参考。方法对2018年11月至2020年1月于上海市(复旦大学附属)公共卫生临床中心感染与免疫科门诊就诊的372例未启动ART的HIV/AIDS患者进行横断面调查。根据结构化问卷调查内容,收集HIV/AIDS患者的基本信息、吸烟状况、高血压、糖尿病、CVD家族史和HIV相关因素等。分别使用弗雷明汉风险评分和HIV感染者抗病毒药物的不良事件的数据[data collection on adverse events of anti-HIV drugs,D∶A∶D(R)]评分对纳入患者进行10年内发生CVD风险评估。采用logistic回归分析10年CVD风险评估≥10%的影响因素。结果372例患者中,男339例(91.13%),女33例(8.87%),年龄为34(18,80)岁。12.20%(41/336)的患者有高血压病史,5.71%(21/368)的患者有糖尿病病史,30.16%(111/368)的患者CD4+T淋巴细胞计数<200/μL。368例进行血脂指标检查的患者中,高密度脂蛋白胆固醇(high density lipoprotein-cholesterol,HDL-C)降低者199例(54.08%),三酰甘油升高者136例(36.96%),总胆固醇升高者44例(11.96%),低密度脂蛋白胆固醇升高者36例(9.78%)。他汀类药物使用率为9.09%(4/44)。365例符合D∶A∶D(R)评分要求的患者10年CVD风险评估≥10%的影响因素有年龄≥50岁[比值比(odds ratio,OR)=216.71,95%可信区间(confidence interval,CI)72.70~749.01,P<0.01)和HDL-C<1.0 mmol/L(OR=6.35,95%CI 2.22~18.09,P<0.01)。233例符合弗雷明汉风险评分要求的患者10年CVD风险评估≥10%的影响因素有年龄≥50岁(OR=7.79,95%CI 3.24~18.75,P<0.01)和CD4+T淋巴细胞计数<200/μL(OR=1.88,95%CI 0.10~3.56,P<0.05)。结论未启动ART的HIV/AIDS患者发生CVD的相关风险因素较多,10年内发生CVD的风险高,但对高脂血症干预率低。年龄≥50岁、CD4+T淋巴细胞计数<200/μL和HDL-C<1.0 mmol/L的患者发生CVD风险相对更高。CVD风险因素的筛查与评估应纳入未启动ART的HIV/AIDS患者的临床管理常规。

Objective To investigate the risk factors of cardiovascular diseases(CVD)in human immunodeficiency virus/acquired immunodeficiency syndrome(HIV/AIDS)patients who did not receive anti-retroviral therapy(ART),and to provide reference for the follow-up ART scheme selection and CVD monitoring and management.Methods A cross-sectional survey was conducted on 372 HIV/AIDS patients who did not initiate ART in the Department of Infection and Immunity,Shanghai Public Health Clinical Center,Fudan University from November 2018 to January 2020.According to the structured questionnaire,the basic information of HIV/AIDS patients,traditional risk factors of CVD(including smoking status,hypertension,diabetes,CVD family history)and HIV related factors were collected.The Framingham risk score and the data collection on adverse events of anti-HIV drugs(D∶A∶D(R))score were used to evaluate the risk of CVD for 10 years.Logistic regression was used to analyze the influencing factors of CVD risk score≥10%in 10 years.Results Among the 372 patients,339(91.13%)were male and 33(8.87%)were female.The age was 34(18,80)years.The incidence of hypertension and diabetes were 12.20%(41/336)and 5.71%(21/368),respectively.There were 111 cases(30.16%,111/368)with CD4+T lymphocyte count<200/μL.Among 368 patients who underwent blood lipid test,high density lipoprotein-cholesterol(HDL-C)decreased in 199 cases(54.08%),triglyceride increased in 136 cases(36.96%),total cholesterol elevated in 44 cases(11.96%),and low density lipoprotein-cholesterol increased in 36 cases(9.78%).Statins were administrated in four cases(9.09%,4/44).Among the 365 patients who met the D∶A∶D(R)score,age≥50 years old(odds ratio(OR)=216.71,95%confidence interval(CI)72.70-749.01,P<0.01)and HDL-C<1.0 mmol/L(OR=6.35,95%CI 2.22-18.09,P<0.01)were risk factors for 10-year CVD risk score≥10%.Among 233 patients who met the requirements of Framingham score,age≥50 years old(OR=7.79,95%CI 3.24-18.75,P<0.01)and CD4+T lymphocyte count<200/μL(OR=1.88,95%CI 0.10-3.56,P<0.05)were risk factors for 10-year CVD risk≥10%.Conclusions There are many CVD risk factors among patients who have not initiated ART.The patients have high scores of 10-year CVD risk,while the intervention rate is low.Patients have higher CVD risks when age≥50 years old,CD4+T lymphocyte count<200/μL and HDL-C<1.0 mmol/L.Therefore,screening and risk assessment of CVD risk factors should be included in the routine management and care of HIV/AIDS patients without ART initiation.