分析成年愛滋病毒感染者代謝症候群及心血管疾病的風險

研究背景：台灣的愛滋病治療與照顧已達世界先進國家水準，目前愛滋病毒感染者遇到的問題不再只是愛滋病毒伺機性疾病造成的死亡問題，而是因為慢性疾病、發炎及藥物副作用所造成的血脂異常，骨質疏鬆症，糖尿病…等，其中心血管疾病風險上升及罹病率的增加。研究方法：此研究是前瞻性世代研究 (IRB approval number CS14034)以個案報告書的方式在103年6月到105年4月期間，收集台灣中部某醫學中心病人資料，依據收案和排除條件來過濾可用資料，再利用SPSS 18版軟體進行統計分析，進而找出愛滋病毒感染病人心血管疾病風險相關因子。研究結果：本研究總共有200人，平均年齡32.9歲，未治療組45人，已治療組155人。結果顯示愛滋病毒感染者，未治療組及已治療組產生代謝症候群比例分別為18% 和31%，相較於佛萊明罕心血管疾病風險數值4.7 %±4.20 和3.87%±5.92。未治療組三酸甘油酯>151 mg/dL為7人 (15.6%) 和未治療組為56人 (36.6%)，P值為0.008具有統計上的差異。未治療組HDL<40 mg/dl為33人 (76.7%)，相較於已治療組為78人 (51.0%)，P值為0.003具有統計上的差異。在已治療組蛋白酶抑制劑和非核苷酸反轉錄酶抑制劑及嵌入酶抑制劑使用Tukey 確實差異 (Honestly Significant Difference, HSD) 檢定分析法兩兩比較之下，三酸甘油酯明顯高於其他兩組，F值分別為0.010和0.036 (F值大於等於0.05為顯著)。結論： 成年男性愛滋病毒感染者，未治療組代謝症候群比例低於已治療組。但可能因為佛萊明罕心血管疾病風險數值中未治療組HDL偏低，所以十年內罹患心血管疾病風險數值略高於治療組。蛋白酶抑制劑會使三酸甘油酯上升，造成心血管風險比率升高。

Background: Human Immunodeficiency Virus (HIV) / Acquired Immunodeficiency Syndrome (AIDS) treatment and care quality in Taiwan are comparable to the high income countries in the world. AIDS-induced dead is not the only one problem that should be concerned. Moreover, increased morbidity of osteoporosis, diabetes mellitus and cardiovascular diseases caused from chronic inflammation of blood vessels (or vasculitis) and pharmaceutical side effects are also turned into the important issues in HIV management.Methods:We conducted a prospective cohort study for surveillance the risk factors in cardiovascular disease and metabolic syndrome in adult HIV positive patients at a tertiary care hospital in central Taiwan. (IRB approval number CS14034). We collected data from June 2014 to April 2016. After exclusion criteria eliminating, the data were statistically analyzed using IBM SPSS Modeler V18.0.0. Those relevant factors between cardiovascular risk and HIV-infected patients were investigated. Results:A total of 200 patients’ data were collected and the population with a mean age of 32.9 divided into two groups (45 treatment-naive subjects and 155 treatment-experienced subjects). Incidences of metabolic syndrome between treatment naive and experienced groups are 18% versus 31%, respectively. The Framingham Risk Score (FRS) for naive and experienced groups are 4.7±4.2 vesus 3.87±5.92, respectively. High triglyceride (TG>150mg/dl) in naive and experienced groups are 15.6% versus 36.6% (P=0.008), whereas, low HDL (HDL<40mg/dl) present in naive and experienced group are 76.7% vesus 51% (P=0.003), respectively. In experienced group, treatment with Protease inhibitors (PIs) have higher triglyceride levels using Tukey Honestly Significant Difference (HSD) analytic method when compared between non-nucleotide reverse transcriptase inhibitors and Integrase inhibtors F=0.010 and F=0.036, respectively (F value equal or more than 0.05 is significant difference). Conclusion:The risk for metabolic syndrome in naive group is lower than experienced HIV-infected men. In contrast, Framingham Risk Score in naive group is higher than experienced group which may be resulted from low HDL level without drug treatment upon HIV infection. Protease inhibitors increase triglyceride level in experienced group that indicate higher cardiovascular risk when compared with non-nucleotide reverse transcriptase inhibitors and integrase inhibitors.