Impact Of Long-term Highly Active Antiretroviral Therapy On Metabolism In AIDS Patients

Background:Employing long-term highly active antiretroviral therapy(HAART)for acquired immune deficiency syndrome(AIDS)patients can effectively suppress the proliferation of human immunodeficiency virus(HIV),delay the progression improve life qualities of the patients and finally reduce mortality.However,long term HAART could also lead to a variety of adverse reactions,such as osteoporosis,chronic kidney disease,coronary heart disease,acute myocardial infarction,fatty malnutrition syndrome and chronic liver disease,which lead to the increase of non-AIDS-related mortality.The early stage of those diseases mentioned before usually accompanied by changes in biochemical and metabolic indexes.And there are still rare researches focused on these problems in China.Our research aimed to investigate the adverse reactions and metabolic abnormity in AIDS patients after long-term HAART and through analyzing the effects of different HAART options on biochemical and metabolic changes,we can benefit patients.Method:This research included 110 AIDS patients who received HAART in the First Affiliated Hospital of Zhejiang University Medical School,during January 2012 to June 2016,The patients were divided into different groups:(1)TDF group vs non-TDF group,and we can compare the different characteristics of renal function,calcium and phosphorus metabolism among patients at different time periods.(2)LPV/r group vs non-LPV/r group,and we can compare the different characteristics of lipid metabolism among patients at different time periods.Statistical_analysis was performed using SPSS 19 software.Result:(1)Compared with the baseline,the TDF group can cause renal tubular injury and bone metabolism abnormity in AIDS patients,Compared with the levels of GFR[(120.71±62.85vs.110.08 ± 39.18)mL/min]and serum phosphate[(1.25±0.19vs.1.22±0.21)mmol/L]increased after 6 months treatment in TDF group,but the difference was not statistically(p>0.05),serum calcium[(2.31±0.13 vs.2.25±0.17mmol/L)],serum-ALP[99(79.5-124)vs.80(60.5-96)U/L]number rose significantly(p<0.05).As trestment continued,the levels of GFR,serum calcium and serum phosphate declined,while the serum-ALP number was still increasing.Compared with the baseline,after 24 months of HAART,the level of serum phosphate[(1.07±0.21vs.1.22±0.21)mmol/L](p<0.05)declined sighificantly,while serum-ALP[105(89-119)vs.80(60.5-96)U/L]increased.Compared with the 6 months,after 24 months of HAART the levels of GFR[(104.7±33.9vs.120.71±62.81)mL/min]and serum calcium[(2.2±0.16vs.2.31±0.13)mmol/L](p<0.05)went an apparent decline.Compared with the non-TDF group,the level of serum calcium and phosphate in TDF group were decreased significantly after 24 months of HAART,[(2.20±0.16vs.2.30±0.12)mmol/L],[(1.07±0.19vs.1.17±0.19)mmol/L](p<0.05)?(2)Compared with the baseline,the LPV/r group can suffer from rising of bold lipid and cholesterol levels,especially TG and Tch(p<0.05).After receiving 12 months of HAART,the levels of TG[(2.49±1.55 vs.1.49±0.81)mmol/L],Tch[(4.80±1.49 vs.3.68±0.84)mmol/L],HDL[(1.16±0.53 vs.0.91 ±0.28)mmol/L](p<0.05)were significantly higher than the baseline.As trestment continued,the levels of TG and Tch increased,meanwhile the HDL number declined.Further more,the level of TG[(2.66±1.41vs.1.49±0.81)mmol/L]and Tch[(4.75±1.12vs.3.68±0.84)mmol/L]kept increasing when tested after receiving 24 months of HAART(p<0.05).Compared with non-LPV/r group,the levels of TG and Tch in LPV/r group were increased significantly since 12 months of HAART,[(2.49±1.55vs.1.72±0.91)mmol/L],[(4.80±1.49vs.4.21±0.86)mmol/L](p<0.05).Conclusion:HAART is effective for patients with AIDS,but long-term HAART can have impact on renal function,bone,blood lipid metabolism in AIDS patients.HAART with TDF mainly lead to renal tubular injury and bone metabolic abnormalities,GFR decreased,Ca and P decreased,ALP increased;HAART with LPV/r mainly caused abnormal blood lipid metabolic,especially TG and Tch increased.Demostic free of antivirals need to be further improved and optimized.The individual treatment process should be closely monitored,and timely intervention and adjustment are especially needed.