愛滋病毒感染者服用高效能抗反轉錄病毒療法後代謝症候群的盛行率及相關因素

Abstract

摘要 背景與目標：高效能抗反轉錄病毒療法可能會增加愛滋病毒感染者發生代謝症候群的風險，代謝症侯群的發生對於長期服用抗反轉錄病毒療法的感染者的健康來說是一大威脅。本研究的目的為調查台灣愛滋病毒感染者服用高效能抗反轉錄病毒療法後出現代謝症候群之盛行率及相關因子。 方法：我們採用橫斷性調查法，調查時間為 2008年5月至2009年5月，針對在臺灣大學附設醫院接受治療的愛滋病毒感染者，收集其基本人口學資料，身高、體重、腰圍、血壓，以及臨床檢驗結果；我們使用病歷回顧的方式，調查感染者服用高效能抗反轉錄病毒療法之狀況。我們採用2005年AHA/NHLBI-ATPⅢ所修訂的診斷標準做為診斷代謝症候群的標準，腰圍則是採用亞洲人的標準。 結果：我們一共收集877位個案，個案平均年齡為38.7歲，其中75.3%是男同性戀者，80.7%個案接受高效能抗反轉錄病毒療法，而88.7%個案的T細胞免疫球數≧200 cells/µl。我們發現210位有代謝症候群，代謝症候群盛行率為26.2%。在羅吉斯迴歸分析中，我們調整了年齡、性別、抽菸狀況、家族病史、以及愛滋病毒感染者被診斷時初次的T細胞免疫球數和愛滋病毒量之後，我們發現服用蛋白酶抑制劑者與代謝症候群之間仍然有很強的相關性 ，勝算比(odds ratio [OR], 1.63; 95% confidence interval [CI], 1.10-2.43)。此外，服用高效能抗反轉錄病毒療法超過六年以上、蛋白酶抑制劑三年以上者，以及核苷酸反轉錄酶抑制劑者大於六年以上者，與未服用藥物者比較，在調整潛在的干擾因子後，有代謝症候群的勝算比分別是1.96 (95% CI, 1.13-3.42)，1.78 (95% CI, 1.03-3.07)，及1.91 (95% CI, 1.11-3.30)。 結論：台灣愛滋病毒感染者服用高效能抗反轉錄病毒療法以及長期服用蛋白酶抑制劑、核苷酸反轉錄酶抑制劑與代謝症候群具有高度正相關。

Abstract Background: Metabolic complications related to antiretroviral therapy are increasingly recognized as challenges to long-term management of HIV infection. We investigated the prevalence of and factors associated with metabolic syndrome among HIV-infected patients who are ethnic Chinese in the era of highly active antiretroviral therapy. Methods: A cross-sectional survey was performed to collect information of demographic and clinical characteristics and antiretroviral therapy prescribed among 877 patients with a mean age of 38.7 years who sought HIV care and received highly active antiretroviral therapy at a designated hospital for HIV care in Taiwan. The modified Adult Treatment Panel III criteria were used to define metabolic syndrome after adjusting for Asians in waist circumference. Results: Of the 877 patients, 75.3% were male homosexuals, 80.7% were receiving antiretroviral therapy, and 88.7% had CD4 counts ≧200 cells/µl when the survey was conducted. A total of 210 patients (26.2%) fulfilled the criteria for metabolic syndrome. In multiple logistic regression analysis after adjustment for age, gender, smoking status, family history of diabetes, cardiovascular disease and hypertension, and baseline CD4 and plasma HIV RNA load, use of protease inhibitors was the strongest associated factor with metabolic syndrome (odds ratio [OR], 1.63; 95% confidence interval [CI], 1.10-2.43). In addition, exposure to protease inhibitors for 3 years or greater, to highly active antiretroviral therapy for 6 years or greater, and to nucleoside reverse-transcriptase inhibitor(s) for 6 years or greater was statistically significantly associated with development of metabolic syndrome with an adjusted OR of 1.96 (95% CI, 1.13-3.42), 1.78 (95% CI, 1.03-3.07), and 1.91 (95% CI, 1.11-3.30), respectively. Conclusions: This is the first study to demonstrate the high prevalence of metabolic syndrome among HIV-infected patients who are ethnic Chinese. Receipt of HAART and prolonged exposure to protease inhibitors and nucleoside reverse transcriptase inhibitor(s) were associated with increased prevalence for metabolic syndrome.