长期联合抗反转录病毒治疗对人类免疫缺陷病毒感染/艾滋病患者心血管疾病风险的影响

Effect of long-term combination anti-retroviral therapy on cardiovascular disease risks in human immunodeficiency virus/acquired immunodeficiency syndrome patients

目的分析长期接受联合抗反转录病毒治疗(combination anti-retroviral therapy,cART)的人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染/艾滋病(acquired immunodeficiency syndrome,AIDS)患者发生心血管疾病(cardiovascular disease,CVD)的风险及相关影响因素。方法收集2018年至2020年来自全国多中心的长期接受cART的HIV感染/AIDS患者队列的基线数据,并采用倾向性评分匹配方法,按年龄和性别匹配未接受过cART的HIV感染/AIDS患者作为对照。采用抗病毒药物不良事件的数据简化模型(data collection adverse events of anti-human immunodeficiency virus drugs reduced model,D:A:D[R])评分、弗雷明汉风险评分(Framingham risk score,FRS)和动脉粥样硬化性心血管疾病(atherosclerotic cardiovascular disease,ASCVD)风险评分,分别评估长期治疗组和未治疗组患者的10年CVD风险。采用logistic回归分析评估10年CVD高风险的影响因素。结果共纳入301例长期治疗的HIV感染/AIDS患者和300例未治疗的HIV感染/AIDS患者,平均年龄为39.8岁,男性患者490例(81.5%)。基于D:A:D[R]评分,长期治疗组和未治疗组10年CVD风险评估≥10%者分别占4.3%(13/301)和6.3%(19/300);基于FRS,长期治疗组和未治疗组10年CVD风险评估≥10%者分别占13.4%(36/269)和10.6%(28/264);基于ASCVD风险评分,长期治疗组和未治疗组10年CVD风险≥7.5%者分别占10.4%(14/135)和13.8%(17/123)。3种CVD风险评估模型均显示,长期治疗组和未治疗组的10年CVD高风险发生率差异均无统计学意义(均P>0.050)。经多因素logistic回归分析显示,D:A:D[R]评估10年CVD风险≥10%的危险因素为年龄≥50岁、吸烟、高血压、糖尿病、血脂异常、CD4^(+)T淋巴细胞计数<200×10^(6)/L[调整后的比值比(adjusted odds ratio,AOR)=697.48、4622.28、23.11、25.95、27.72、18.25,均P<0.010];FRS评估10年CVD风险≥10%的危险因素为年龄≥50岁、男性、吸烟、高血压、糖尿病、血脂异常(AOR=53.51、4.52、36.93、36.77、6.15、3.84,均P<0.050);ASCVD风险评分评估10年CVD风险≥7.5%的危险因素为年龄≥50岁、男性、吸烟、高血压、糖尿病(AOR=18.48、14.11、14.81、13.42、12.41,均P<0.050)。结论未发现长期接受cART对HIV感染/AIDS患者CVD风险产生影响。HIV感染/AIDS患者CVD高风险的影响因素为年龄≥50岁、吸烟、高血压、糖尿病、血脂异常等传统CVD危险因素,以及CD4^(+)T淋巴细胞计数<200×10^(6)/L。

Objective To explore the risks of cardiovascular disease(CVD)and influencing factors in human immunodeficiency virus/acquired immunodeficiency syndrome(HIV/AIDS)patients with long-term combination anti-retroviral therapy(cART).Methods The baseline data from the multi-center prospective cohort of HIV/AIDS patients who received long-term cART from 2018 to 2020 were collected.cART-naive HIV/AIDS patients were matched by age and gender using the propensity score matching(PSM)as controls.Data collection adverse events of anti-human immunodeficiency virus drugs reduced model(D:A:D[R])score,Framingham risk score(FRS)and atherosclerotic cardiovascular disease(ASCVD)risk score were used to assess the 10-year CVD risk in patients with long-term cART treatment and in cART-naive patients.Logistic regression analysis was used to assess the risk factors related to high 10-year CVD risk.Results A total of 301 HIV/AIDS patients received long-term cART and 300 cART-naive HIV/AIDS patients were included,with an average age of 39.8 years old.There were 490 male accounting for 81.5%.Based on the D:A:D[R]score,4.3%(13/301)of patients in the long-term cART group had a 10-year CVD risk assessment of≥10%,and 6.3%(19/300)of patients in the cART-naive group.Based on the FRS,13.4%(36/269)of patients in the long-term cART group had a 10-year CVD risk assessment of≥10%,and 10.6%(28/264)in the cART-naive group.Based on the ASCVD risk score,10.4%(14/135)of patients in the long-term cART group had a 10-year CVD risk assessment of≥7.5%,and 13.8%(17/123)in the cART-naive group.There was no significant difference in the prevalence of high 10-years CVD risk between the long-term cART group and the cART-naive group assessed by any of risk equations(all P>0.050).By multivariate logistic regression analysis,the risk factors associated with 10-year CVD risk≥10%assessed by D:A:D[R]model were age≥50 years,smoking,hypertension,diabetes,dyslipidemia and CD4^(+)T lymphocyte count<200×10^(6)cells/L(adjusted odds ratio(AOR)=697.48,4622.28,23.11,25.95,27.72 and 18.25,respectively,all P<0.010).The risk factors associated with 10-year CVD risk≥10%assessed by FRS were age≥50 years,male,smoking,hypertension,diabetes and dyslipidemia(AOR=53.51,4.52,36.93,36.77,6.15 and 3.84,respectively,all P<0.050).The risk factors associated with 10-year CVD risk≥7.5%assessed by ASCVD risk score were age≥50 years,male,smoking,hypertension,diabetes(AOR=18.48,14.11,14.81,13.42 and 12.41,respectively,all P<0.050).Conclusions Long-term cART has no significant effect on the 10-year CVD risk in HIV/AIDS patients.Higher CVD risk in HIV/AIDS patients are mainly associated with CD4^(+)T lymphocyte counts<200×10^(6)cells/L and traditional CVD risk factors,including age≥50 years old,smoking,hypertension,diabetes and dyslipidemia.