武汉市HIV/AIDS患者抗病毒治疗前后血脂变化及影响因素

Changes in blood lipids and influencing factors before and after antiretroviral therapy in HIV/AIDS patients in Wuhan City

目的 了解武汉市HIV/AIDS患者接受抗病毒治疗前血脂异常的患病情况和接受抗病毒治疗后血脂异常发病率及其影响因素。方法 采用回顾性队列研究的方法,分析2004—2021年武汉市HIV/AIDS患者资料。TC、TC任意一项水平升高判定为血脂异常。采用logistic回归模型分析基线血脂异常的影响因素,采用Cox比例风险模型分析患者接受抗病毒治疗后新发血脂异常的影响因素。TG、TC任意一项水平升高判定为高脂血症。结果共纳7 546名HIV/AIDS患者,基线患有高脂血症者占31.31%(2 363/7 546),未患血脂异常占68.69%(5 183/7 546)。基线未患高脂血症者随访的平均人年数是3.48,其中32.32%(1 675/5 183)在随访中出现高脂血症,总发病密度为9.30/100人年。多因素logistic回归分析显示,年龄、性别、BMI与基线高脂血症存在显著正相关,CD4细胞计数<200个/μL与基线高脂血症呈显著负相关。多因素Cox模型分析显示,接受抗病毒治疗后新发高脂血症与BMI、CD4细胞计数、初始抗病毒治疗方案含克力芝,TDF等因素呈显著正相关。结论 BMI较高、含有克力芝和/或依非韦伦的治疗方案会显著增加HIV/AIDS患者出现血脂异常的风险,应加强对这部分人群血脂随访监测。

Objective To understand the prevalence of dyslipidemia before antiviral treatment and the incidence of dyslipidemia after antiviral treatment and its influencing factors in HIV/AIDS patients in Wuhan.Methods A retrospective cohort study was used to analyze the data of HIV/AIDS patients in Wuhan from 2004 to 2021.An elevated level of either TC or TC was judged as dyslipidemia.Logistic regression model was used to analyze the influencing factors of baseline dyslipidemia,and Cox proportional hazards model was used to analyze the influencing factors of new-onset dyslipidemia after antiviral treatment.An elevated level of any one of TG and TC was judged as hyperlipidemia.Results A total of 7546 HIV/AIDS patients were recruited,31.31%(2363/7546)had hyperlipidemia at baseline,and 68.69%(5183/7546)did not suffer from dyslipidemia.The average person-years of follow-up for those without hyperlipidemia at baseline was 3.48,of which 32.32%(1675/5183)developed hyperlipidemia during follow-up,and the total incidence density was 9.30/100 person-years.Multivariate Logistic regression analysis showed that age,gender,and BMI were significantly positively correlated with baseline hyperlipidemia,and CD4 cell count<200 cells/μL were significantly negatively correlated with baseline hyperlipidemia.Multivariate Cox model analysis showed that new-onset hyperlipidemia after antiviral treatment was significantly positively correlated with BMI,CD4 cell count,initial antiviral treatment regimen containing Kaletra,Efavirenz and other factors.Conclusion Higher BMI,treatment regimens containing Kaletra and/or Efavirenz can significantly increase the risk of dyslipidemia in HIV/AIDS patients,and follow-up monitoring of blood lipids in this group of people should be strengthened.