| Objective Acquired immune deficiency syndrome(AIDS)is caused by infection with the Human immunodeficiency virus(HIV).At present,it is still one of the important public health problems affecting human health.The advent of Antiretroviral therapy(ART)has greatly reduced the morbidity and mortality of AIDS related diseases to a certain extent,but HIV patients will receive an increasing incidence of all kinds of chronic complications(dyslipidemia,diabetes,cardiovascular diseases,etc.).At present,most studies on the metabolism of blood fat and blood sugar in AIDS patients come from abroad,but there are few domestic studies and the follow-up time is short.The aging of AIDS patients makes it urgent for us to understand the lipid and blood glucose metabolism of these patients,so as to reduce the occurrence of various complications.MethodThe HIV/AIDS patients who received antiretroviral therapy for the first time in the outpatient department of Infection,Dali Bai Autonomous Prefecture People’s Hospital from January 2011 to December 2012 were screened,the general demographic characteristics and clinical data of HIV/AIDS patients were collected,and the basic characteristics of the subjects were described.The prevalence rates of dyslipidemia and hyperglycemia before and after antiviral treatment were obtained respectively,and the risk factors of dyslipidemia and hyperglycemia were gradually screened out.Result1.A total of 336 patients were included in the study,180 of whom were followed for 9 years and 156 for 10 years.The baseline total cholesterol level was 4.14±1.0mmol/L,the baseline total triglyceride level was 1.49(1.08,2.17)mmol/L,and the baseline fasting blood glucose level was 5.17(4.77,5.59)mmol/L.The prevalence of total dyslipidemia before ART was 47.0%(158/336),the prevalence of elevated total triglycerides was 40.8%(137/336),and the prevalence of elevated total cholesterol was12.8%(43/336).The prevalence of hyperglycemia was 12.5 %(42/336).The prevalence of total dyslipidemia after ART was 94.9 %(319/336),the prevalence of increased total triglycerides was 91.7 %(308/336),and the prevalence of increased total cholesterol was 73.8 %(248/336).The prevalence of hyperglycemia was 50.0% (168/336).Dyslipidemia was mainly characterized by elevated total triglycerides.2.Before receiving antiviral therapy,univariate logistic analysis showed that age ≥45 years old(OR=3.72,95%CI 1.02-13.5,P=0.046),route of infection was sexual transmission(OR=3.53,95%CI 1.35-9.27,P=0.01)is a risk factor for hypercholesterolemia.Age ≥45 years(OR=14.48,95%CI 1.87-111.96,P=0.01)was associated with hyperglycemia.Multivariate logistic analysis showed that age ≥45 years old(OR=4.22,95%CI 1.13-15.74,P=0.032)and sexual transmission(OR=3.13,95%CI 1.11-8.82,P=0.031)were independent risk factors for hypercholesterolemia Patients ≥45 years of age(OR=12.14,95%CI 1.54-95.4,P=0.018)were at greater risk for hyperglycemia.3.After antiviral therapy,univariate logistic analysis showed that females(OR=0.45,95%CI 0.2-1.01,P=0.049)were protective factors for hypertriglyceridemia.Females(OR=1.97,95%CI 1.18-3.26,P=0.009)and sexual transmission(OR=3.85,95%CI2.3-6.45,P < 0.001)were risk factors for hypercholesterolemia,and baseline disease course ≥5 years(OR=0.51,95%CI 0.28-0.92,P=0.025),combined with HCV infection(OR=0.29,95%CI 0.18-0.42,P < 0.001),the current clinical stage of WHO was in the AIDS stage(OR=0.4,95%CI 0.18-0.87,P=0.02)was a protective factor for hypercholesterolemia.Age 30-44 years old(OR=3.64,95%CI 1.73-7.69,P=0.001),age≥45 years old(OR=10,95%CI 4.3-23.3,P < 0.001),baseline dyslipidemia(OR=1.62,95%CI 1.05-2.49,P=0.029),low baseline CD4 cell count,and co-infection with hepatitis C(OR=2.08,95%CI 1.32-3.27,P=0.002)had an increased risk of hyperglycemia,while women(OR=0.45,95%CI 0.29-0.7,P < 0.001),patients using a regimen containing LPV/r(OR=0.48,95%CI 0.3-0.77,P=0.002)had a lower risk of hyperglycemia.Multivariate logistic analysis showed that female patients(OR=0.29,95%CI 0.11-0.74,P=0.010)had less risk of high triglycerides than those treated with lopinavir/Ritonavir(OR=7.07,95%CI 1.56-32.01,P=0.011)was an independent risk factor for hypertriglyceridemia.Older age,HCV infection(OR=2.60,95%CI 1.22-5.54,P=0.013)and baseline dyslipidemia(OR=1.87,95%CI 1.14-3.07,P=0.013)were independent risk factors for hyperglycemia.4.In addition,subjects were divided into HIV-coinfected and non-coinfected groups.Higher baseline aspartic aminotransferase and alanine aminotransferase levels were associated with a lower prevalence of high cholesterol in HIV-coinfected patients(58.2% vs 82.7%,P < 0.001).The prevalence of hyperglycemia was higher(61.5 % vs43.5 %,P=0.001).Conclusion1.The prevalence rates of dyslipidemia and hyperglycemia were high in HIV/AIDS patients who received antiretroviral therapy for the first time,and the prevalence rates of dyslipidemia and hyperglycemia were further increased after antiviral therapy.The dyslipidemia was mainly caused by the increase of total triglycerides.2.Lopinavir/ritonavir therapy increases the risk of dyslipidemia and is not recommended for primary patients with dyslipidemia.Baseline dyslipidemia can increase the risk of hyperglycemia in HIV/AIDS patients and should be intervened early.3.For patients infected with HIV and hepatitis C virus,more attention should be paid to blood glucose metabolism.4.No HIV-related factors(such as HIV infection time,viral load,CD4+T lymphocyte count)have been found to be related to the occurrence of dyslipidemia and hyperglycemia. |
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