Incidence And Risk Factors Of Hyperlipemia In Treatment-na?ve Males With Human Immunodeficiency Virus Receiving Combination Antiretroviral Therapy:A Retrospective Cohort Study

Objective To investigate the incidence rate and related factors of hypercholesterolemia and hypertriglyceridemia in treatment-na?ve males with human immunodeficiency virus(HIV)receiving combined antiretroviral therapy(c ART).Methods The male HIV-infected patients who started c ART in the hospital from January 2012 to December 2018 were included,and their serum total cholesterol(TC),triglyceride(TG)and other relevant parameters were collected during treatment.The incidence of hypercholesterolemia and hypertriglyceridemia during treatment was counted.A Cox proportional hazard regression model were used to analyze the influencing factors of hypercholesterolemia and hypertriglyceridemia.Results Study 1:365 newly treated male HIV-infected patients were included,and 42patients had hypercholesterolemia within 1050.3 person-years.The incidence rate was4.0/100 person-years.Multivariate Cox regression analysis showed that risk factors for hypercholesterolemia during c ART in newly treated male HIV-infected patients included ALT≥40 U/L before treatment(HR=2.173,95%CI:1.077-4.383,P=0.030),baseline TC marginally elevated(5.2 mmol/L≤TC<6.2 mmol/L)(HR=8.456,95%CI:4.016-17.805,P<0.001),and being treated with the regimen of lamivudine[3TC]+zidovudine(AZT)+efavirenz[EFV](HR=2.979,95%CI:1.353-6.555,P=0.007)or"other regimen"(62.1%AZT included)(HR=2.664,95%CI:1.066-6.657,P=0.036,the 3TC+TDF+EFV regimen as the reference for analysis).Study 2:In 666.7 person-years,hypertriglyceridemia occurred in 140 patients(triglyceride≥2.3 mmol/L[200 mg/d L]),and the incidence rate was 21.0 per 100person-years(Patients who took the 3TC+tenofovir disoproxil fumarate[TDF]+EFV regimen accounted for 77.0%of the total patients.).Multiple Cox regression analysis showed that baseline CD4/CD8 ratio<0.20(hazard ratio[HR],2.705[95%confidence interval(CI):1.381–5.296];P=0.004},body mass index(BMI)≥24.0kg/m~2(HR,1.768[95%CI:1.225–2.552];P=0.002),borderline high triglyceride at baseline(HR,3.457[95%CI:2.162–5.527];P<0.001),and 3TC+AZT+EFV regimen(HR,2.702[95%CI:1.593–4.581];P<0.001),or 3TC+TDF+lopinavir/ritonavir(LPV/r)regimen(HR,4.349[95%CI:2.664–7.102];P<0.001)were independent risk factors for hypertriglyceridemia.Conclusions The incidences of hypercholesterolemia and hypertriglyceridemia during the course of c ART treatment in males with HIV are relatively high.The main risk factors for the occurrence of hypercholesterolemia included the marginally increased total cholesterol level at baseline,the high baseline ALT level and the use of the3TC+AZT+EFV regimen or regimens with AZT.The main risk factors influencing hypertriglyceridemia occurrence are a low baseline CD4/CD8 ratio,overweight and obesity,and the use of AZT or LPV/r in the c ART regimen.