TLE方案对初治男男性行为者的HIV/AIDS患者血脂及致动脉粥样硬化率的影响

Effect of TLE as the initial antiviral treatment on lipid profiles and atherogenic ratios of MSM with HIV/AIDS

目的了解替诺福韦+拉夫米定+依非韦伦(TLE)方案对初治男男性行为者(MSM)的艾滋病病毒(HIV)感染者/艾滋病(AIDS)患者(简称HIV/AIDS患者)血脂及致动脉粥样硬化率的影响。方法回顾性分析MSM的HIV/AIDS患者的临床资料。比较基线及抗病毒治疗(ART)96周血脂及致动脉粥样硬化率的变化特点。结果共收集MSM的HIV/AIDS患者209例,基线表现为甘油三酯(TG)升高(20.57%),高密度脂蛋白(HDL)降低(46.89%);治疗96周表现为TG升高(24.40%)、总胆固醇(TC)升高(5.26%)、低密度脂蛋白(LDL)升高(10.05%)和HDL降低(11.00%);比较ART前后血脂指标,差异均有统计学意义(P均<0.05)。比较基线及治疗96周,血浆致动脉硬化指数(AIP)P<0.05,Castelli危险指数-1(CRI-1)P<0.05,Castelli危险指数-2(CRI-2)P<0.05,动脉硬化指数(AC)P<0.05,差异均有统计学意义。治疗96周致动脉粥样硬化率改善的患者例数增加(AIP>0.1减少9例;CRI-1>5.0减少3例;CRI-2>3.3减少14例;AC≥4.0减少6例)。结论使用TLE进行ART 96周对MSM的HIV/AIDS患者单项血脂指标有不良影响,但可更好预测心血管疾病风险的致动脉粥样硬化率未提示心血管疾病发生的风险有增加。

Objective To study the effect of Tenofovir Disoproxil Fumarate+Lamivudine+Efavirenz(TLE)on the lipid profiles and the atherogenic ratios in HIV infected patients among men who have sex with men(MSM).Methods A retrospective study was conducted among HIV/AIDS patients of MSM to compare the difference in lipids parameters and atherogenic ratios before and 96 weeks after treatment with TLE.Results 209 HIV infected MSM patients without HAART mainly manifested high TG(20.57%)and low high density lipoprotein(HDL)(46.89%).Dyslipidemia after 96-week HAART was manifested as increased TG(24.40%),total cholestero(TC)(5.26%),LDL(10.05%)and low HDL(11.00%).There were statistically significant differences of TG,TC,LDL and HDL before and after HAART(P<0.05).There were statistically significant differences in atherogenic index of plasma(AIP),castelli risk index(CRI)-1,CRI-2 and AC before and after HAART(P<0.05).The number of patients with a high-risk atherogenic ratios decreased(AIP>0.1 decreased by 9 cases;CRI-1>5.0 decreased by 3 cases;CRI-2>3.3 decreased by 14 cases;AC≥4.0 decreased by 6 cases)after 96-week HAART.Conclusion There are adverse effects of lipid parameters after 96-week TLE treatment for MSM with HIV/AIDS.However,the atherogenic ratios,which can better predict the risk of cardiovascular disease,do not indicate an increased risk of cardiovascular disease after 96-week treatment with TLE in MSM patients.