Lipodistrofija indukovana kombinovanom antiretrovirusnom terapijom kod HIV/AIDS bolesnika
Sažetak
Uvod/Cilj. Visokoaktivna antiretrovirusna terapija (HAART) dovela je do značajnog sniženja mortaliteta i morbiditeta kod bolesnika sa HIV/AIDS-om. Lipodistrofija, sindrom definisan perifernim gubitkom masnog tkiva, praćen istovremenom centralnom gojaznošću, predstavlja dokumentovani neželjeni efekat HAART–a. Cilj ovog istraživanja bio je da se utvrdi incidencija lipodistrofije i da se determinišu potencijalni faktori rizika od njenog nastanka i razvoja kod pacijenata sa HIV/AIDS-om koji su lečeni HAART-om. Metode. Retrospektivnom studijom bili su obuhvaćeni svi HIV/AIDS pacijenti koji nikada ranije nisu bili lečeni HAART-om i koji su započinjali naznačenu terapiju u periodu od 01.10.2001. do 01.10.2010. u Centru za HIV/AIDS Instituta za infektivne i tropske bolesti, Beograd, Srbija. Univarijantna i naknadna multivarijanta logistička regresiona analiza primenjene su da bi se utvrdio odnos šansi (OR) i interval poverenja od 95% (95% CI) u cilju procene relativnog rizika od razvoja lipodistrofije. Kaplan-Majerova analiza korišćena je u cilju procene verovatnoće razvoja lipodistrofije tokom vremena. Sve korišćene statističke analize rađene su primenom SPSS softverskog paketa, pri čemu je p < 0.05 smatrano statistički značajno. Rezultati. U studiju je bilo uključeno ukupno 840 HIV/AIDS-pacijenata, 608 muškog i 232 ženskog pola, koji su praćeni 5,6 ± 2,8 godina. Prevalencija lipodistrofije iznosila je 69,2%. Univarijantna i naknadna multivarijantna regresiona analiza identifikovale su ženski pol (OR = 1,6; 95% CI = 1,1–3,49, p = 0,04), istovremenu infekciju hepatitis C virusom (OR = 3,31, 95% CI =1,3–6,8, p < 0,01), AIDS pre započinjanja HAART-a (OR = 3,7; 95% CI = 1,7–6,1, p < 0,01), nukleozidne inhibitore reverzne transkriptaze (OR = 2,1, 95% CI = 1,7–3,3, p < 0,01) i proteazne inhibitore (OR = 6,1, 95% CI = 4,1 – 9,7, p < 0,01), kao nezavisne prediktore za razvoj lipodistrofije kod pacijenata inficiranih HIV-om. Zaključak. Uprkos značajnom produženju života pacijenata sa HIV/AIDS-om, toksičnost indukovana primenom HAART-a i dalje predstavlja značajan problem. Upravo zato, praćenje pojave i razvoja lipodistrofije, kao neželjenog efekta HAART-a, jeste od izuzetne važnosti.
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