HAART - Associated Hyperlipidemia and Hyperglycemia in HIV

HAART - Associated Hyperlipidemia and Hyperglycemia in HIV

60
¢Õπ·°àπ‡«™ “√ ªï∑’Ë 32 ©∫—∫摇»… 4 ‡¥◊Õπ情¿“§¡ 2551
HAART - Associated Hyperlipidemia and Hyperglycemia
in HIV Patients, Surin Hospital
Jumreon Luatngoen M.D., Diploma Thai Board of Internal Medicine
Department of Medicine, Surin Hospital
Abstract
Background Treating HIV patient with HAART (Highly Active Antiretroviral Therapy)
regimen greatly reduced mortality rate and prolonged patientûs life. However life - long treatment may
affect glucose and lipid metabolism which increased risk of cardiovascular diseases.
Method A retrospective simple randomized study was conducted in HIV clinic, Surin Hospital
during April 2001 to December 2007. Two hundred of HIV patients treated with HAART regimen
were randomized from overall 817 cases. Patientûs CD4, lipid profile and fasting blood sugar were
monitored every 24 weeks.
Results The HIV patients have been treated with HAART regimen for average 39.35 ± 17.58
months. Prevalence of hyperlipidemia in men was higher than women (p = 0.004) but there was no
difference in blood glucose level between two groups. Patients developed Diabetes Mellitus,
hypercholesterolemia, hypertriglyceridemia and high LDL cholesterol (10.5%, 34.0%, 35.5% and 6.5%
respectively). There was no difference of dyslipidemia complication among HAART regimens
because NRTI and NNRTI regimens were mostly prescribed over than PI regimens.
Conclusion Initiation of HAART regimen in HIV infected patient has favorable long - term
efficacy, however long - term metabolic complications particularly DM and dyslipidemia potentially
increase risk of cardiovascular diseases and required intensive monitoring for these complications.
Keywords : HAART, Hyperlipidemia, Hyperglycemia
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¿“«–‰¢¡—π·≈–πÈ”µ“≈„π‡≈◊Õ¥ Ÿß∑’Ëæ∫„πºŸâªÉ«¬‡Õ¥ å∑’Ë√—∫ª√–∑“π
¬“µâ“π‰«√— ‡Õ¥ å ª√– ‘∑∏‘¿“æ Ÿß (HAART)
„π‚√ß欓∫“≈»Ÿπ¬å ÿ√‘π∑√å
®”‡√‘≠ ≈«¥‡ß‘π æ.∫., «.«. Õ“¬ÿ√»“ µ√å∑—Ë«‰ª
°≈ÿà¡ß“πÕ“¬ÿ√°√√¡ ‚√ß欓∫“≈»Ÿπ¬å ÿ√‘π∑√å ®—ßÀ«—¥ ÿ√‘π∑√å
∫∑§—¥¬àÕ
À≈—°°“√·≈–‡Àµÿº≈ ªí®®ÿ∫—π°“√√—°…“ºŸâªÉ«¬‚√§‡Õ¥ å¥â«¬¬“µâ“π‰«√— ‡Õ¥ å∑’Ë¡’ª√– ‘∑∏‘¿“æ Ÿß
(highly active antiretroviral therapy = HAART) “¡“√∂≈¥Õ—µ√“°“√µ“¬≈ßÕ¬à“ß¡“° ºŸâªÉ«¬‚√§‡Õ¥ å
“¡“√∂¡’Õ“¬ÿ¬◊π ¢≥–‡¥’¬«°—πµâÕß√—∫ª√–∑“𬓵â“π‰«√— ‡Õ¥ åµ≈Õ¥™’«‘µ‡ªìπ‡«≈“π“π ∑”„À⇰‘¥¿“«–
·∑√°´âÕπ®“°¬“‰¥â «—µ∂ÿª√– ߧå„π°“√»÷°…“‡æ◊ËÕ»÷°…“«à“¡’¿“«–πÈ”µ“≈ ·≈–¿“«–‰¢¡—π„π‡≈◊Õ¥ Ÿß¡“°
‡æ’¬ß„¥ ´÷Ëß®–¡’º≈∑”„À⇰‘¥‚√§À≈Õ¥‡≈◊Õ¥À—«„®µ’∫
«‘∏’°“√»÷°…“ ‡ªìπ°“√»÷°…“¢âÕ¡Ÿ≈¬âÕπÀ≈—ß„πºŸâªÉ«¬‡Õ¥ 废â„À≠à∑’Ë¡“√—∫°“√√—°…“ ‚¥¬°“√√—∫
ª√–∑“𬓵â“π‰«√— ‡Õ¥ å¢Õߧ≈‘π‘§¿Ÿ¡‘§ÿâ¡°—π ‚√ß欓∫“≈»Ÿπ¬å ÿ√‘π∑√å ‚¥¬°“√ ÿࡵ—«Õ¬à“ߺŸâªÉ«¬¡“
200 §π ®“°ºŸâªÉ«¬∑’Ë√—∫ª√–∑“𬓵â“π‰«√— ‡Õ¥ å ºŸâ„À≠à∑—ÈßÀ¡¥ 817 §π µ—Èß·µà ‡¥◊Õπ‡¡…“¬π æ.». 2544
∂÷߇¥◊Õπ∏—𫓧¡ æ.». 2550
º≈°“√»÷°…“ ‡¡◊ËÕºŸâªÉ«¬‰¥â√—∫¬“µâ“π‰«√— ‡Õ¥ 凪ìπ‡«≈“‡©≈’ˬ 39.35 ± 17.58 ‡¥◊Õ𠧫“¡º‘¥
ª°µ‘¢Õ߉¢¡—πæ∫„π‡æ»™“¬¡“°°«à“‡æ»À≠‘ß·µà‰¡àæ∫§«“¡·µ°µà“ß„π°“√‡ª≈’ˬπ·ª≈ß√–¥—∫πÈ”µ“≈„π
‡≈◊Õ¥√–À«à“߇æ»À≠‘ß·≈–‡æ»™“¬ ¡’¿“«–πÈ”µ“≈ Ÿß 10.5%, Total choleslerol Ÿß 34% ¡’ Triglycerides
Ÿß 35.5% LDL Ÿß 6.5% ‰¡à¡’§«“¡·µ°µà“ß√–À«à“ß Ÿµ√¬“∑’Ë„™â´÷Ëß à«π¡“°‡ªìπ NRTI ·≈– NNRTI
‰¡à¡’ PI
√ÿªº≈°“√»÷°…“ ‡¡◊ËÕ√—°…“ºŸâªÉ«¬‡Õ¥ å¥â«¬¬“µâ“π‰«√— ‡Õ¥ åª√– ‘∑∏‘¿“æ Ÿß ºŸâªÉ«¬®–¡’Õ“¬ÿ¬◊π
¡“°¢÷Èπ °“√∑’Ë√—∫ª√–∑“𬓇ªìπ‡«≈“π“π∑”„À⇰‘¥‚√§‡∫“À«“π ·≈–‰¢¡—π„π‡≈◊Õ¥ Ÿß ®÷ßµâÕßµ‘¥µ“¡
¥Ÿ·≈ºŸâªÉ«¬Õ¬à“ß„°≈♑¥
§”À≈—° : HAART, ¿“«–‰¢¡—π„π‡≈◊Õ¥ Ÿß, ¿“«–πÈ”µ“≈„π‡≈◊Õ¥ Ÿß
62
∫∑π”
°“√√—°…“°“√µ‘¥‡™◊ÈÕ(1) human immunodeficiency virus (HIV) ¥â«¬¬“µâ“π‰«√— HIV ∑”„Àâ
Õ— µ √“°“√‡®Á ∫ ªÉ « ¬·≈–Õ— µ √“°“√µ“¬¢ÕߺŸâ µ‘ ¥ ‡™◊È Õ
HIV ≈¥≈ß™— ¥ ‡®π ¢≥–‡¥’ ¬ «°— π ºŸâ ªÉ « ¬µâ Õ ß√— ∫
ª√–∑“𬓵≈Õ¥™’«‘µº≈¢â“߇§’¬ß¢Õ߬“°Á‡°‘¥¢÷Èπ
µ“¡¡“Õ¬à“߇ÀÁπ‰¥â™—¥„π®”π«ππ’È ¿“«–πÈ”µ“≈„π
‡≈◊Õ¥ Ÿß ‰¢¡—π„π‡≈◊Õ¥ Ÿß‡ªìπÕ“°“√¢â“߇§’¬ß¢Õß
¬“∑’Ëæ∫‰¥â¡“°¢÷Èπµ“¡≈”¥—∫ ´÷Ëß„πµà“ߪ√–‡∑»∑’Ë
√Ë”√«¬°“√¥Ÿ·≈§π‰¢â‡Õ¥ å∑”‰¥âÕ¬à“ߥ’ ¡’§π‰¢â
®”π«π¡“°„™â¬“„π°≈ÿà¡ PI(1-4) æ∫«à“¿“«–πÈ”µ“≈
„π‡≈◊ Õ ¥ Ÿ ß ¿“«–‰¢¡— π Ÿ ß æ∫∑—È ß Cholesterol
·≈– Triglycerides ‰¥â¡“° §◊Õ 1-7% , 25% ·≈–
38.2% µ“¡≈”¥—∫(1,5-6) „πª√–‡∑»‰∑¬¢âÕ¡Ÿ≈¬—ß¡’
ºŸâ∑”°“√»÷°…“πâÕ¬ 𓬷æ∑¬å«’√«—≤πå ¡‚π ÿ∑∏‘
·≈–§≥–‰¥â »÷ ° …“„π§π‰¢â ¢ Õß‚√ß欓∫“≈
∫”√“»π√“¥Ÿ√ °√ÿ߇∑æœ ´÷Ë߇ªìπ§π‰¢â∑’Ë„™â¬“°≈ÿà¡
GPOvir (NRTI, NNRTI) æ∫«à“À≈—߉¥â√—∫¬“‰ª
ª√–¡“≥ 2 ªï æ∫«à“ºŸâªÉ«¬¡’¿“«–‡∫“À«“π 1.1%,
‰¢¡—π LDL Ÿß ¡“°°«à“ 130 mg/dl 28.7% LDL
¡“°°«à“ 160 mg/dl 8.0% ·≈– Triglycerides
¡“°°«à“ 400 mg/dl 6.9%(7)
„π‚√ß欓∫“≈»Ÿ π ¬å ÿ √‘ π ∑√å ®“°°“√
∑”ß“π„π§≈‘π‘°¿Ÿ¡‘§ÿâ¡°—π ´÷Ëß„Àâ°“√¥Ÿ·≈√—°…“
ºŸâªÉ«¬‡Õ¥ 废â„À≠à ‡ªìπ®”π«π 1,500 √“¬ ¡’ºŸâ√—∫
ª√–∑“𬓵â“π‰«√— ‡Õ¥ å 817 √“¬ µ—Èß·µà‡¥◊Õπ
‡¡…“¬π æ.». 2544 ∂÷߇¥◊Õπ∏—𫓧¡ æ.». 2550
æ∫«à“ºŸâªÉ«¬¡’¿“«–πÈ”µ“≈„π‡≈◊Õ¥ Ÿß ¿“«–‰¢¡—π
„π‡≈◊ Õ ¥ Ÿ ß ®÷ ß ∑”„À⠢⠓ 懮⠓ π„®∑”°“√»÷ ° …“
ºŸâ ªÉ « ¬°≈ÿà ¡ π’È ‡æ√“–«à “ À“°‡°‘ ¥ ¿“«–‡∫“À«“π
‰¢¡—π„π‡≈◊Õ¥ ŸßÕ¬Ÿàπ“π Ê À≈“¬ Ê ªï ∑”„À⇰‘¥
¿“«–À≈Õ¥‡≈◊Õ¥À—«„®µ’∫µ“¡¡“‡ªìπº≈„À⺟âªÉ«¬
‡ ’¬™’«µ‘ ‰¥â(3,6)
Ÿµ√¬“∑’Ë„™â ¡’
1) GPOvir ¢π“¥ 30 mg ‡ªìπ Ÿµ√À≈—°
¢Õπ·°àπ‡«™ “√ ªï∑’Ë 32 ©∫—∫摇»… 4 ‡¥◊Õπ情¿“§¡ 2551
2) D4T, 3TC, EFV
3) AZT, 3TC, EFV
4) AZT, 3TC, NVP
5) Ÿµ√∑’Ë¡’ PI ´÷Ë߇ªìπ®”π«ππâÕ¬¡“°
«—µ∂ÿª√– ߧå
‡æ◊ËÕµ‘¥µ“¡¥Ÿº≈¢â“߇§’¬ß¢Õ߬“µâ“π‰«√— ‡Õ¥ å ª√– ‘∑∏‘¿“æ Ÿß (HAART) ∑’Ë¡’º≈µàÕ√–¥—∫
πÈ”µ“≈„π‡≈◊Õ¥ ·≈–‰¢¡—π„π‡≈◊Õ¥ ´÷ßË ª√–°Õ∫¥â«¬
Cholesterol √«¡, Triglycerides, HDL ·≈– LDL
„πºŸâ ªÉ « ¬∑’Ë √— ∫ ª√–∑“𬓇ªì π √–¬–‡«≈“π“π
‡æ◊ËÕªÑÕß°—π¿“«–‚√§À≈Õ¥‡≈◊Õ¥À—«„®µ’∫
§”𑬓¡»—æ∑å
NRTI §◊Õ ¬“°≈ÿà¡ nucleoside analogs
À√◊Õ nucleoside reverse transcriptase inhibitors
AZT (Zidovudine)
D4T (Stavudine)
3TC (Lamivudine)
NNRTI §◊Õ¬“°≈ÿà¡ non - nucleoside
reverse transcriptase inhibitors
NVP (Nevirapine)
EFV (Efavirene)
PI §◊Õ¬“°≈ÿà¡ protease inhibitors
IDV (Indinavir)
RTV (Ritronavir)
LPV/r (Lopinavir/Ritronavir)
SQV (Saquinavir)
«‘∏’°“√»÷°…“
√Ÿª·∫∫°“√»÷°…“
‡ªìπ°“√»÷°…“¢âÕ¡Ÿ≈¬âÕπÀ≈—ß ®“°∫—π∑÷°
ºŸâªÉ«¬‡Õ¥ 废â„À≠à∑’Ë√—∫ª√–∑“𬓵â“π‰«√— ‡Õ¥ å
ª√– ‘∑∏‘¿“æ Ÿß (HAART) ¢Õߧ≈‘π‘°¿Ÿ¡‘§ÿâ¡°—π
‚√ß欓∫“≈»Ÿπ¬å ÿ√‘π∑√å ™à«ß‡¥◊Õπ‡¡…“¬π æ.».
Khon Kaen Hospital Medical Journal Vol. 32 Supplement 4 May 2008
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2544 ∂÷ß∏—𫓧¡ æ.».2550 ‚¥¬°“√ ÿࡵ—«Õ¬à“ß
ºŸªâ «É ¬ ®”π«π 200 §π®“°ºŸ∑â ‰’Ë ¥â√∫— ¬“µâ“π‰«√— ‡Õ¥ å
ºŸâ„À≠à∑—ÈßÀ¡¥ 817 §π §‘¥‡ªìπ 24.45% À√◊Õ
ª√–¡“≥ 25% ¢Õߪ√–™“°√ºŸªâ «É ¬∑’‰Ë ¥â√∫— ¬“∑—ßÈ À¡¥
°“√𔇠πÕ¢âÕ¡Ÿ≈·≈–°“√«‘‡§√“–Àå∑“ß ∂‘µ‘
°“√𔇠πÕ¢â Õ ¡Ÿ ≈ µ— « ·ª√‡™‘ ß ª√‘ ¡ “≥
®–· ¥ß§à “ ‡ªì π ®”π«π √â Õ ¬≈– ·≈–§à “ ‡©≈’Ë ¬
°“√‡ª√’ ¬ ∫‡∑’ ¬ ∫§à “ §«“¡·µ°µà “ ߢÕß§à “ ‡©≈’Ë ¬
·µà≈–°≈ÿà¡„™â paired sample test ·≈–°“√‡ª√’¬∫
‡∑’¬∫√–À«à“ß°≈ÿ࡬“„™â independent samples test
· ¥ß§à“ mean ± SD ·≈–§«“¡·µ°µà“ߢÕß°≈ÿà¡
‡æ»Õ“¬ÿ °—∫¿“«–πÈ”µ“≈„π‡≈◊Õ¥ ¿“«–‰¢¡—π„π
‡≈◊Õ¥„™â chi-square (x2) ‚¥¬¡’§«“¡·µ°µà“ß∑“ß ∂‘µ‘
‡ªìπ p-value < 0.05
°“√«‘ ‡ §√“–Àå ∑ “ß ∂‘ µ‘ „ ™â ‚ ª√·°√¡
§Õ¡æ‘«‡µÕ√å SPSS ‡«Õ√å™—Ëπ 11 ‚¥¬°”Àπ¥
√–¥—∫§«“¡¡’π—¬ ”§—≠∑“ß ∂‘µ‘∑’Ë p < 0.05
º≈°“√»÷°…“
®“°µ“√“ß∑’Ë 1 æ∫«à“ πÈ”Àπ—°, §à“ CD4,
‰¢¡—π™π‘¥ Cholesterol √«¡, Triglycerides, LDL
¡’°“√‡ª≈’ˬπ·ª≈ßÕ¬à“ß¡’π—¬ ”§—≠∑“ß ∂‘µ‘ ·¡â¬“∑’Ë
„™â®–‡ªìπ°≈ÿà¡ NRTI, NNRTI ·µà§à“ HDL ∑’ˇæ‘Ë¡
‰¡à¡“°π—Èπ ‡π◊ËÕß®“° HDL ·√°‡√‘Ë¡π—Èπ ŸßÕ¬Ÿà ·≈â«
§à“∑’ˇæ‘Ë¡¢÷Èπ®÷߉¡à¡’§«“¡·µ°µà“ßÕ¬à“ß¡’π—¬ ”§—≠
®“°¢âÕ¡Ÿ≈∑’Ë ÿà¡¡“‡æ◊ËÕ∑”°“√»÷°…“ 200 §π
ª√–°Õ∫¥â«¬ ºŸâ™“¬ 101 §π §‘¥‡ªìπ
√âÕ¬≈– 50.5
ºŸâÀ≠‘ß 99 §π §‘¥‡ªìπ√âÕ¬≈– 49.5
Õ“¬ÿ
38.90 ± 7.55 ªï
πÈ”Àπ—°
51.64 ± 9.15 °‘‚≈°√—¡
√–¬–‡«≈“∑’√Ë ∫— ª√–∑“𬓮π¡’√–¥—∫πÈ”µ“≈
À√◊Õ‰¢¡—π Ÿß
39.35 ± 17.58 ‡¥◊Õπ
º≈∑“ßÀâÕߪؑ∫—µ‘°“√·√°‡¢â“‚§√ß°“√
πÈ”µ“≈„π‡≈◊Õ¥ (FBS) 90.84 ± 31.35 mg/dL
Total cholesterol 171.69 ± 46.24 mg/dL
Triglycerides 161.01 ± 139.86 mg/dL
HDL
44.72 ± 13.79 mg/dL
LDL
96.54 ± 35.22 mg/dL
CD4
84.35 ± 84.97 cell(x106/L)
% CD4
7.61 ± 6.72
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¢Õπ·°àπ‡«™ “√ ªï∑’Ë 32 ©∫—∫摇»… 4 ‡¥◊Õπ情¿“§¡ 2551
∑“ß ∂‘µ‘
Ÿµ√¬“∑’„Ë ™â¡“°∑’ Ë ¥ÿ §◊Õ GPOvir 30 ¡’„™â 74%
D4T, 3TC, EFV ¡’„™â 19%
Ÿµ√Õ◊Ëπ Ê (¡’ AZT „π Ÿµ√) ·≈–‰¡à¡’ PI
¡’„™â 7%
®“°µ“√“ß∑’Ë 2 æ∫«à“
FBS Ÿß¢÷Èπ 21 √“¬ §‘¥‡ªìπ 10.5%
Total cholesterol Ÿß¢÷Èπ 68 √“¬ §‘¥‡ªìπ 34%
Triglycerides Ÿß¢÷πÈ 71 √“¬ §‘¥‡ªìπ 35.5%
HDL Ÿß¢÷Èπ 126 √“¬ §‘¥‡ªìπ 63%
LDL Ÿß¢÷Èπ 13 √“¬ §‘¥‡ªìπ 6.5%
„π√“¬∑’Ë¡’√–¥—∫‰¢¡—πÀ√◊ÕπÈ”µ“≈„π‡≈◊Õ¥
Ÿß‡≈Á°πâÕ¬®–„À⧫∫§ÿ¡Õ“À“√°àÕπ 3 ‡¥◊Õπ·≈â«
µ√«®¥Ÿº≈∑“ßÀâÕߪؑ∫—µ‘°“√Õ’°§√—Èß®÷ß®–‡√‘Ë¡¬“≈¥
‰¢¡—π À√◊Õ¬“√—°…“‡∫“À«“π ‡¡◊ËÕ‡ª√’¬∫‡∑’¬∫
√–À«à“ß Ÿµ√¬“∑’Ë„™â Ÿµ√ 1, Ÿµ√ 2 À√◊Õ Ÿµ√Õ◊Ëπ Ê
‰¡àæ∫§«“¡·µ°µà“ßÕ¬à“߇ÀÁπ‰¥â™—¥ ´÷ËßÕ“®®–µâÕß
¡’°“√µ‘¥µ“¡ ·≈–»÷°…“µàÕ‰ª
Total cholesterol ª°µ‘ <200 mg/dL
TG = Triglycerides
ª°µ‘ <200 mg/dL
HDL = High Density Lipoprotein
ª°µ‘ >40 mg/dL
LDL = Low Density Lipoprotein
ª°µ‘ <130 mg/dL
FBS = Fasting Blood Sugar
ª°µ‘ <126 mg/dL
Khon Kaen Hospital Medical Journal Vol. 32 Supplement 4 May 2008
®“°µ“√“ß∑’Ë 3 ·≈– 4 · ¥ß§«“¡ —¡æ—π∏å
√–À«à“ß‡æ» Õ“¬ÿ ¢ÕߺŸâªÉ«¬«à“¡’§«“¡‡°’ˬ«¢âÕß°—∫
¿“«–πÈ” µ“≈À√◊ Õ ¿“«–‰¢¡— π „π‡≈◊ Õ ¥ Ÿ ß À√◊ Õ ‰¡à
æ∫«à“ √–¥—∫‰¢¡—π„π‡≈◊Õ¥ Ÿß„π‡æ»™“¬¡“°°«à“
‡æ»À≠‘ß·µà√–¥—∫πÈ”µ“≈∑’ˇæ‘Ë¡¢÷Èπ‰¡à‡ª≈’ˬπ·ª≈ß
µ“¡‡æ» à«πÕ“¬ÿ∑’Ë¡“°¢÷Èπ¡’º≈µàÕ°“√‡ª≈’ˬπ·ª≈ß
∑—È ß πÈ” µ“≈·≈–‰¢¡— π ‚¥¬∑”„Àâ √ –¥— ∫ πÈ” µ“≈
·≈–‰¢¡— π „π‡≈◊ Õ ¥ Ÿ ß ¢÷È π µ“¡Õ“¬ÿ ∑’Ë ¡ “°¢÷È π
Õ¬à“ß¡’π—¬ ”§—≠∑“ß ∂‘µ‘
«‘®“√≥å
°“√√—°…“ºŸâªÉ«¬‡Õ¥ å¥â«¬¬“µâ“π‰«√— ‡Õ¥ å
ª√– ‘∑∏‘¿“æ Ÿß (HAART) ¡’º≈∑”„Àâ°“√µ‘¥‡™◊ÈÕ
≈¥≈ß·≈–Õ—µ√“µ“¬≈¥≈ß(1) ·µà°“√∑’˺ŸâªÉ«¬µâÕß√—∫
ª√–∑“𬓵à Õ ‡π◊Ë Õ ß‡ªì 𠇫≈“π“π®–‡°‘ ¥ ¿“«–
·∑√°´âÕπ®“°¬“¡“°¢÷Èπ „π∑’Ëπ’È∑”°“√»÷°…“‡√◊ËÕß
πÈ”µ“≈„π‡≈◊Õ¥ Ÿß (‡∫“À«“π) ¿“«– hypercholesterolemia ·≈–¿“«– hypertriglyceridemia „π
°“√»÷°…“„πµà“ߪ√–‡∑» æ∫«à“ Ÿµ√¬“∑’Ë¡’ PI
®–æ∫°“√‡ª≈’ˬπ·ª≈ß Ÿß°«à“ „𬓰≈ÿà¡ NRTI
·≈– ¬‘Ëßæ∫‰¥âπâÕ¬„π°≈ÿà¡ NNRTI(2-4, 7-8) ®“°°“√
»÷°…“„πºŸâªÉ«¬¢Õߧ≈‘π‘°¿Ÿ¡‘µâ“π∑“π‚√ß欓∫“≈
»Ÿ π ¬å ÿ √‘ π ∑√å Ÿ µ √¬“∑’Ë „ ™â à « π¡“°‡ªì π Ÿ µ √¬“
GPOvir ´÷Ë߇ªìπ°≈ÿà¡ NRTI ·≈– NNRTI æ∫«à“
¡’°“√‡ª≈’ˬπ·ª≈ß∑—ÈßπÈ”µ“≈„π‡≈◊Õ¥ Cholesterol
·≈– Triglycerides Ÿß¢÷Èπ §◊Õ 10.5%, 34% ·≈–
65
35.5% µ“¡≈”¥—∫ „πµà“ߪ√–‡∑» ´÷Ëß„™â PI ‡ªìπ
à«π„π„À≠àæ∫‡∫“À«“π ‰¢¡—π Ÿß ™π‘¥ Cholesterol
·≈– Triglycerides Ÿß 1-7%, 25% ·≈– 38.2%(1,5-6)
µ“¡≈”¥—∫
„π∫“ß°“√»÷°…“æ∫«à“ Ÿµ√∑’Ë¡’ PI Õ¬Ÿà
∑”„À⇰‘¥‰¢¡—π‡ª≈’¬Ë π·ª≈߉¥â¡“°°«à“ Ÿµ√∑’‰Ë ¡à¡’ PI
∂÷ß 4.2 ‡∑à“(2) ·≈–æ∫‡æ»™“¬¡“°°«à“‡æ»À≠‘ß
·¡â«à“ Ÿµ√∑’Ë„™â„π‚√ß欓∫“≈»Ÿπ¬å ÿ√‘π∑√å®–‡ªìπ
°≈ÿà¡ NRTI ·≈– NNRTI °Áæ∫¿“«–πÈ”µ“≈·≈–‰¢
¡—π„π‡≈◊Õ¥‡ª≈’ˬπ·ª≈ß ‡π◊ËÕß®“°„™â‡ªìπ√–¬–
‡«≈“π“π §◊Õ‡©≈’ˬ 39.35 ± 17.58 ‡¥◊Õπ ´÷Ëß®–æ∫
«à“¡’ Total cholesterol ·≈– Triglycerides Ÿß‡ªìπ
à«π„À≠à ¢≥–‡¥’¬«°—π°Áæ∫¡’¿“«–‰¢¡—π¬â“¬∑’Ë
√à«¡¥â«¬ (lipodystrophy) ‡ªìπ®”π«π¡“° ·≈–
‡™◊Ë Õ «à “ ¡’ § «“¡ — ¡ æ— π ∏å ‚ ¥¬µ√ß°— ∫ ¿“«–‰¢¡— π „π
‡≈◊Õ¥ Ÿß(4,9-11) ´÷Ëß„πµà“ߪ√–‡∑»æ∫«à“ ¿“«–‰¢¡—π
·≈–πÈ”µ“≈„π‡≈◊Õ¥ Ÿß ®–æ∫‡√Á«°«à“¿“«–‰¢¡—π
¬â“¬∑’Ë 3-6 ‡¥◊Õπ(11-12) ·¡â«“à ‚√ß欓∫“≈»Ÿπ¬å √ÿ π‘ ∑√å
æ∫«à“ §π‰¢â∫“ß√“¬¡’¿“«–‰¢¡—π¬â“¬∑’Ë·≈â«·µà
¿“«–‰¢¡—π ·≈–πÈ”µ“≈„π‡≈◊Õ¥¬—ߪ°µ‘Õ¬Ÿà‡ªìπ à«π
¡“° ´÷Ë ß ®–µâ Õ ß¡’ ° “√µ‘ ¥ µ“¡·≈–»÷ ° …“‡æ‘Ë ¡ ‡µ‘ ¡
µàÕ‰ª«à“¡’§«“¡ —¡æ—π∏å°—πÀ√◊Õ‰¡à
§«“¡·µ°µà “ ß√–À«à “ ߇滙“¬·≈–À≠‘ ß
°— ∫ ¿“«–‰¢¡— π „π‡≈◊ Õ ¥æ∫„π‡æ»™“¬¡“°°«à “
‡æ»À≠‘ß ·µà‡∫“À«“π∑’ˇ°‘¥®“°°“√√—∫ª√–∑“π¬“
µâ“π‰«√— ‡Õ¥ åæ∫„π‡æ»À≠‘ß¡“°°«à“‡æ»™“¬(13)
66
¡’¢âÕ§«√√–«—ß „π°“√„™â¬“≈¥‰¢¡—π°≈ÿà¡
Statin √à « ¡°— ∫ ¬“°≈ÿà ¡ PI ®–∑”„Àâ ‡ °‘ ¥ ¿“«–
Phabdomyolysis ‰¥âßà“¬(14) πÕ°®“°π’È¿“«–À≈Õ¥
‡≈◊Õ¥µ’∫ πÕ°®“°®–‡ªìπªí≠À“∑’ËÀ—«„®·≈⫬—ß¡’º≈
µàÕÀ≈Õ¥‡≈◊Õ¥∑’ˉµ¥â«¬(15)
√ÿª
®“°°“√»÷ ° …“¢â Õ ¡Ÿ ≈ æ∫«à “ °“√√— ° …“
ºŸâ ªÉ « ¬‡Õ¥ å ºŸâ „ À≠à ¥â « ¬¬“µâ “ π‰«√— ‡Õ¥ å
ª√– ‘∑∏‘¿“æ Ÿß‡ªìπ√–¬–‡«≈“π“π∑”„À⇰‘¥°“√
‡ª≈’ˬπ·ª≈ߢÕßπÈ”µ“≈·≈– ‰¢¡—π„π‡≈◊Õ¥ Ÿß¢÷Èπ
∑—Èß Cholesterol Triglycerides ·≈– LDL ·¡â„π
µà“ߪ√–‡∑»æ∫¡“°„π°≈ÿà¡ PI ´÷Ëß√–¬–‡«≈“®–‡√Á«
°«à“∑’Ëæ∫„π°“√»÷°…“π’È ´÷Ëß„™â‡«≈“¬“«π“π°«à“
‡π◊ËÕß®“°¬“∑’Ë„™â‡ªì𬓰≈ÿà¡ NRTI ·≈– NNRTI
®÷ß∑”„Àâ‡√“µâÕßµ√–Àπ—°«à“ ®–µâÕßµ‘¥µ“¡¿“«–
·∑√°´âÕπ®“°¬“Õ¬à“ß„°≈♑¥¬‘Ëߢ÷Èπ ‡æ◊ËÕªÑÕß°—π
°“√‡°‘¥‚√§À≈Õ¥‡≈◊Õ¥À—«„®µ’∫µàÕ‰ª πÕ°®“°π’È
¿“«–·∑√°´â Õ πÕ◊Ë π Ê °Á µâ Õ ß√–¡— ¥ √–«— ß ¥â « ¬
‡™àπ°—π
°‘µµ‘°√√¡ª√–°“»
¢Õ¢Õ∫§ÿ≥ 𓬷æ∑¬å ∏ß™—¬ µ√’«∫‘ ≈Ÿ ¬å«≥‘™¬å
ºŸâÕ”π«¬°“√‚√ß欓∫“≈»Ÿπ¬å ÿ√‘π∑√å ∑’Ë„Àâ°“√
π—∫ πÿπ„π°“√»÷°…“π’È ‡®â“Àπâ“∑’Ë·≈–欓∫“≈
§≈‘π‘°¿Ÿ¡‘§ÿâ¡°—π ‚√ß欓∫“≈»Ÿπ¬å ÿ√‘π∑√å∑’Ë„Àâ
§«“¡™à«¬‡À≈◊Õ „π°“√À“¢âÕ¡Ÿ≈ºŸâªÉ«¬
‡Õ° “√Õâ“ßÕ‘ß
1. ¿‘√ÿ≠ ¡ÿµ ‘°æ—π∏å. ¿“«–·∑√°´âÕπ√–¬–¬“«®“°°“√
°‘𬓵â“π‰«√— ‡Õ¥ å ¢ÕߺŸâµ‘¥‡™◊ÈÕ HIV „π : æ√√≥æ‘»
ÿ«√√≥°Ÿ≈, ™ÿ…≥“ «π°√–µà“¬, ∏’√–æß…å µ—≥±«‘‡™’¬√,
∫√√≥“∏‘°“√. Update on Infectious Diseases 2549
Àπâ“ 359-81.
¢Õπ·°àπ‡«™ “√ ªï∑’Ë 32 ©∫—∫摇»… 4 ‡¥◊Õπ情¿“§¡ 2551
2. Michael P., Dennis S., W. Keith H., Judith A.,
Francesca J., Howard N. et al : Preliminary
Guidelines for the Evaluation and Management of
Dyslipidemia in Adults Infected with Human
Immunodeficiency Virus and Receiving Antiretroviral
Therapy : Recommendations of the Adult AIDS
Clinical Trail Group Cardiovascular Disease Focus
Group. In. Kenneth H. Mayer, Section Editor. Clinical
Infectious Diseases 2000 ; 31 : 1216-24.
3. Paulo Sergio Ramos D., Ricardo Arracs D., Carlos
Frederico L., Joao Yure D., Mecleime Mendes D.,
Edmilda Margues C. Antiretroviral Treatment for
HIV Infection /AIDS and the Risk of Developing
Hyperglycemia and Hyperlipidemia, Rev. Inst. Med.
Trop. S Paulo. 2007 March-April 49(2) 73-8.
4. Mulligan K., Grunfeld C., Tai W.V., Algren H.,
Pang M., Chernoff N.D.et al Hyperlipidemia and
Insulin Resistance Are Induced by Protease
Inhibitors Independent of Changes in Body
Composition in Patients With HIV infection.
Journal of Acquired Immune Deficiency
Syndromes. 2000, 23 : 35-43.
5. Brown T.T., Cole R.S., Li X., Kingsley AL., Palella
J.F., Riddler A.S. et al. Antiretroviral Therapy
and the Prevalence and Incidence of Diabetes
Mellitus in the Multicenter AIDS Cohort Study.
Arch. Internal Medicine 2005 May 23 Vol 165.
1179-85.
6. Montessor V., Press N., Harris M., Akagi L.,
Montaner J., Adverse effects of antiretroviral therapy
for HIV infection. CMAJ 2004 January 20, 170(20).
7. Manosuthi W., Chaovavanich A., Prasithsirikul W.,
Athichathanabadi C., Likanansakul S., In thong Y.
et al Efficacy and Metabolic Complications after
96 Weeks of a Generic Fixed dose Combination of
Stavudine, Lamivudine and Nevirapine among
Advanced HIV. Infected Patients. The 4th IAS
Conference on HIV Pathogenesis, Treatment and
Prevention. 2007 Sydney Australia.
Khon Kaen Hospital Medical Journal Vol. 32 Supplement 4 May 2008
8. Brarnbilla A.M., Novati R., Calori G., Meneghini
E., Vacchini D., Luzi L. et al. Stavudine or indinavir
containing regimens are associated with an increased
risk of diabetes mellitus in HIV-infected individuals.
AIDS 2003, Sept5, Vol 17(13). 1993-5.
9. Riddler S., Smit E., Cole S., Li R., Chmiel J., Dobs
A. et al. Impact of HIV infection and HAART on
Serum Lipids in Men. JAMA 2003 June 11,
Vol 289 No. 22, 2978-82.
10. Rosario P, Jesus S., Josefa R., Mercedes G., Manuel
M. Factors associated with the development of
diabetes mellitus in HIV-infected patients on
antiretroviral therapy : a case - control study.
AIDS 2003 April 11 Vol 17(6) 933-5.
11. Leow M, Addy CL, Mantzoros C. Human
Immunodeficiency Virus/Highly Active Antiretroviral
Therapy-Associated Metabolic Syndrome : Clinical
Presentation, Pathophysiology, and Therapeutic
Strategies. The Journal of Clinical Endocrinology &
Metabolism 2003, May 88(5) 1961-76.
67
12. A Hughes C., P Cashi R., T Eurich D., Houston S.
Risk factor for new-onset diabetes mellitus in
patients receiving protease inhibitor therapy. Can. J
Infect Dis Med Microbiol 2005 July/August
Vol 16 No 4. 230-2.
13. Pernerstorfer-Schoen H., Jilma B. Perschler A.,
Wichlas S., Schindler K., Schindl A.et al. Sex
differences in HAART associated dyslipidemia.
AIDS 2001 Vol 15 No 6. 725-34.
14. Wynn GH,Zapor MJ., Smith B.H., Wortmann G.,
Oesterheld JR., Armstrong S.C. et al. Antiretrovirals,
Part I : Overview, History, and Focus on Protease
Inhibitors.
15. Carr A. Cardiovascular disease, diabetes and renal
disease in HIV infection. 11th Bangkok Symphosium
on HIV Medicine, 2008 Jan 16-18 Bangkok
Thailand.