2018年深圳市初治HIV感染者血脂异常患病率及影响因素分析

目的了解深圳市初治HIV感染者血脂异常的患病率及其高危因素。方法以2018年深圳市第三人民医院收治的未接受过抗反转录病毒治疗的成年HIV感染者作为研究对象,收集其基本特征和临床资料,分析纳入对象的TC、TG、LDL-C和HDL-C的平均水平,血脂异常总患病率及高TC、高TG、高LDL-C和低HDL-C的患病率。采用多变量Logistic回归模型分析各项血脂异常的影响因素。结果共纳入1195例初治HIV感染者,血脂异常率为49.04%(586/1195),其中男、女患病率分别为49.86%和39.80%(χ2=3.649,P=0.056);高TC、高TG、高LDL-C和低HDL-C的比率分别为13.31%(159/1195)、15.40%(184/1195)、33.72%(403/1195)和9.21%(110/1195)。多因素分析结果显示,年龄大(≥35岁)和肥胖是高TC的独立危险因素;年龄大、超重、肥胖、CD4/CD8比值低是高TG的独立危险因素;男性、糖尿病、超重、肥胖、CD4/CD8比值低、WHO HIV临床分期IV期、HIV RNA≥105 IU/ml是低HDL-C的危险因素;糖尿病、超重、肥胖、CD4/CD8比值低、HIV RNA载量≥105 IU/ml是高LDL-C的危险因素。结论初治HIV感染者血脂异常的患病率高,影响血脂异常的危险因素包括以年龄大、超重、肥胖、糖尿病等为主的传统因素和以低CD4/CD8比值、WHO HIV临床分期晚、高HIV RNA载量等为主的HIV感染相关因素。建议在临床上对初治的HIV感染者常规筛查血脂,对具有其他代谢异常因素的WHO HIV临床分期晚期人群进行重点的筛查和评估。

Prevalence and influencing factors of dyslipidemia among treatment-naive HIV-infected individuals in Shenzhen in 2018

Objective To explore the prevalence of dyslipidemia and its high-risk factors among treatment-naive HIV-infected individuals in Shenzhen,China.Methods Antiretroviral therapy-naive HIV-infected adults who were treated in Shenzhen Third People’s Hospital in 2018 were enrolled in the study.Their general data and clinical information were collected.The average levels of total cholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C)and high-density lipoprotein cholesterol(HDL-C),the overall prevalence of dyslipidemia,and the prevalences of high TC,high TG,high LDL-C and low HDL-C were analyzed.The influencing factors of dyslipidemia were analyzed using multivariate Logistic regression model.Results A total of 1195 antiretroviral therapy-naive HIV-infected individuals were enrolled in this study.The overall prevalence of dyslipidemia was 49.04%(586/1195),and that in males and females was 49.86%and 39.80%,respectively(χ2=3.65,P=0.060).The prevalences of high TC,high TG,high LDL-C,and low HDL-C was 13.31%(159/1195),15.40%(184/1195),33.72%(403/1195)and 9.21%(110/1195),respectively.Multivariate analysis showed that the elderly(≥35 years old)and obesity were the independent risk factors of high TC.The elderly,overweight,obesity and low CD4/CD8 ratio were the independent risk factors of high TG.The male,diabetes,overweight,obesity,low CD4/CD8 ratio,WHO HIV clinical staging at IV stage,and HIV RNA≥105 IU/mL were the risk factors of low HDL.The diabetes,overweight,obesity,low CD4/CD8 ratio,and HIV RNA≥105 IU/mL were the risk factors of high LDL-C.Conclusions The prevalence of dyslipidemia is high in treatment-naive HIV-infected individuals.The classical factors including the elderly,overweight,obesity,and diabetes,and factors associated with HIV infection including low CD4/CD8 ratio,advanced stage in WHO HIV clinical staging,and high HIV RNA load are the risk factors of dyslipidemia.This study suggests that the routine screening of dyslipidemia for treatment-naive HIV-infected individuals screening and evaluation for those with abnormalities of other metabolism related factors at advanced HIV stage are essential in clinic.