德宏傣族景颇族自治州2004-2019年HIV/AIDS患者接受抗病毒治疗后血脂变化及其影响因素分析

A retrospective cohort study of incident hyperlipoidemia and risk factors among HIV/AIDS patients initiating antiretroviral therapy in Dehong prefecture,2004-2019

目的了解德宏傣族景颇族自治州(简称德宏州)HIV/AIDS患者启动ART前高脂血症患病率和启动ART后高脂血症发病率及其影响因素。方法采用回顾性队列研究的方法,基于国家艾滋病防治基本信息系统,分析德宏州2004-2019年启动ART的HIV/AIDS患者资料。TG、TC任意一项水平升高判定为高脂血症。采用Logistic回归模型分析基线高脂血症的影响因素,采用Cox比例风险模型分析启动ART后新发高脂血症的影响因素。结果共纳入5616名HIV/AIDS患者,基线患有高脂血症者占30.4%(1706/5616),未患高脂血症占69.6%(3910/5616)。基线未患高脂血症者中位随访时间为4.07人年,其中56.6%(2214/3910)在随访中出现高脂血症,总发病密度为22.1/100人年。多因素Logistic回归分析显示,年龄≥30岁、BMI≥24 kg/m^(2)、与基线高脂血症存在显著正相关,CD4细胞计数≥200个/μL、感染途径为注射吸毒与基线高脂血症呈显著负相关。多因素Cox模型分析显示,启动ART后新发高脂血症与BMI介于18.5~23.9和≥24 kg/m^(2)、初始ART方案含克力芝等因素呈显著正相关;基线CD4细胞计数≥200个/μL与新发高脂血症呈负相关。结论BMI较高、初始ART方案包含克力芝为HIV/AIDS患者发生高脂血症的危险性显著大于一般人群,应加强对这部分人群血脂随访监测。

Objective To investigate the prevalence and incidence of hyperlipidemia and risk factors among people living with HIV(PLWH)before and after initiating antiretroviral therapy(ART)in Dehong Prefecture,Yunnan Province,2004-2019.Methods This was a retrospective cohort study of HIV/AIDS patients receiving ART in Dehong prefecture during 2004-2019.Hyperlipidemia was defined as the presence of elevated triglyceride(TG)or elevated total cholesterol(TC)levels.A logistic regression model was used to explore the factors associated with hyperlipidemia before ART initiation,and Cox proportional hazard model was used to analyze the predictors of incident hyperlipidemia after initiating ART.Results 5616 HIV/AIDS cases were included.At baseline,69.6%(3910/5616)HIV/AIDS cases did not have hyperlipidemia,and 30.4%(1706/5616)HIV/AIDS cases had hyperlipidemia at baseline.Among those without hyperlipidemia at baseline,the median follow-up time was 4.07 years,of which 56.6%(2214/3910)developed hyperlipidemia with an overall incidence density of 22.1/100 person-years.In multivariable Cox proportional hazards model,BMI between 18.5-23.9 and BMI≥24 kg/m^(2),initial ART regimens containing LPV/r were significantly and positively associated with hyperlipidemia,whereas baseline CD4 cell count≥200 cells/μL was significantly and negatively associated with hyperlipidemia Conclusion The risk of hyperlipidemia among HIV/AIDS cases with higher BMI and initial ART regimens containing LPV/r were significantly higher than those in the general population.We should strengthen the monitoring of blood lipids among these patients.