馬拉威北部使用抗反轉錄病毒療法之愛滋病患者在代謝危險因子之盛行率

Abstract

背景與目標：隨著抗反轉錄病毒療法（ART）效益的提高和及早開始服用ART的建議，感染人類免疫缺陷病毒（HIV）患者的平均餘命可預期地大幅改善。另一方面，終身使用ART可能導致若干代謝問題，包括肥胖，糖尿病，和高血壓。到目前為止，馬拉威感染愛滋病毒的族群中，肥胖、糖尿病和高血壓的盛行狀況還不清楚。 方法：我們在馬拉威北部的姆祖祖中心醫院，針對感染HIV成年人且正使用ARV治療的患者進行一橫斷性研究。研究期間，每位至愛滋門診追蹤的病人皆會被邀請參與研究，總參與率為97.2％。病人知情同意後，受訓過的現場工作人員開始進行身體測量，血壓檢查，及指尖採血測試血糖。我們依據世界衛生組織（WHO）和美國糖尿病協會的標準來定義肥胖，高血壓，糖尿病。我們將本研究結果與WHO於2009年在馬拉威進行之全國性的調查結果（Stepwise approach to surveillance, STEPS）進行比較。 結果：研究共收集410位參與者資料（男性佔21.0％）。肥胖（BMI (Body mass index)≥30）和體重過重（25≤ BMI <30）的男女性別盛行率分別為男性2.3%（95％CI：0.0-5.5％）和8.1% （95％CI：2.4-13.9％），女性12.0%（95％CI：8.5-15.6％）和26.9%（95％CI：22.0-31.7％）。肥胖和體重過重的情況在女性的盛行皆高於男性。另外，年齡（OR：1.7，95％CI：1.2-2.5）和持續飲酒習慣（OR：5.9，95％CI：2.1-16.1）兩因子，顯著與肥胖相關。高血壓的盛行率為18.1％（95％CI：14.1-21.5％），蔬菜攝取量與此研究族群的高血壓盛行率相關（OR：0.9，95％CI：0.8-1.0）。糖尿病和空腹血糖異常的盛行率分別為2.9%（95％CI：1.3-4.6%）及17.8%（95％CI：10.9-24.7%）。比較調整後的疾病盛行率和STEPS調查結果，本研究呈現較高的肥胖盛行率（8.6% vs. 4.6%）和空腹血糖異常（15.1% vs. 4.2%），較低的高血壓（19.4% vs. 32.9%）和相似的糖尿病（4.4% vs. 5.6%）盛行率。這群愛滋病患有26.1％（95％CI：21.9-30.4％）至少有一項慢性疾病〈肥胖和/或高血壓和/或糖尿病〉同時存在。 結論與討論：我們的研究提供了在馬拉威針對HIV感染人群中長期使用抗反轉錄病毒療法下，代謝危險因子的疾病負擔。代謝危險因子的盛行在這族群是值得關注的問題。長期對非傳染性疾病負擔的影響需要更進一步調查。

Background: With increased availability of antiretroviral therapy (ART), the life expectancy of people with human immunodeficiency virus (HIV) infection is expected to improve substantially. On the other hand, life-long ART may be associated with increased obesity, diabetes, and hypertension. The situation of obesity, diabetes, and hypertension in HIV-infected population in Malawi is unclear. We aim to conduct a survey to gain the prevalence of metabolic risk factors among HIV under ART patients. Methods: We conducted a cross-sectional study including adult HIV-infected patients under ART treatment in a teaching hospital from northern Malawi. All patients who received follow-up at the HIV care and treatment clinic were invited, and the participation rate was 97.2%. After acquiring informed consent, trained field workers performed anthropometric measurements, blood pressure exam, and finger prick test for blood glucose. The prevalence of metabolic risk factors were compared to our study population by the 2009 stepwise approach to surveillance (STEPS) approach in Malawi. Results: This study included 410 participants (21.0% males). The prevalence of obesity (Body mass index (BMI)≥30) and overweight (25≤BMI<30) were 2.3% (95％CI: 0.0-5.5%) and 8.1% (95％CI: 2.4-13.9%) in males, and 12.0% (95％CI: 8.5-15.6%) and 26.9% (95％CI: 22.0-31.7%) in females. There were 18.1% (95% CI: 14.3-21.8%) diagnosed as hypertension. The prevalence of dysglycemia (19.5%, 95% CI: 18.4-20.6%) was higher than that in STEPS survey (9.8%). Old age was the common predictive factor, and significantly associated with these diseases. The comorbidity occupied 26.1% (95％CI: 21.9-30.4%) of all patients. Conclusion: Our study provides an initial assessment of the burden of metabolic risk factors among HIV-infected population under long-term ART treatment in Malawi. The high prevalence of metabolic risk factors in this population need more concerning. Long-term impact of ART treatment on the burden of non-communicable diseases warrants further investigation.