| ObjectiveCurrent HAART treatment of AIDS associated hyperlipidemia syndromes in Chinese medicine research and treatment is still blank. This research is based on the national "Eleventh Five" major projects, and the State Key Basic Research Program of special funding. The researchers analyzed and summarized the characteristics of non-AIDS associated hyperlipidemia and HAART treatment of AIDS associated hyperlipidemia with different groups of symptoms, signs, syndromes, objective indicators and the assessment of the 10-year cardiovascular risk. The features of HAART treatment of AIDS associated hyperlipidemia of the Traditional Chinese Medicine syndromes and 10-year rule and cardiovascular disease risk assessment of the correlation were analyzed. The results will provide the scientific basis of Chinese Medicine treatment of HAART associated hyperlipidemia and reduction of cardiovascular risk and the analysis of Traditional Chinese Medicine syndromes of AIDS-related hyperlipidemia syndromes.Methods:1.Literature ReviewThe literature of AIDS HAART associated hyperlipidemia syndromes was obtained from CNKI and CBM and VIP. The research of Modern Medicine and Chinese Medicine in fields of HAART treatment of AIDS associated hyperlipidemia syndromes were analyzed and summarized.2.Theory research(1) AIDS patients in HAART treatment often appear symptoms such as lipid abnormalities, which greatly increases risk of cardiovascular disease of patients, so HIV-related dyslipidemia is an important aspect of treatment to AIDS. Through research and analysis to non-AIDS primary hyperlipidemia, based on searching related western medicine and TCM literature about AIDS and hyperlipidemia, combining Chinese and foreign contemporary literature's view, to make objective analysis and conclusion on such patients' TCM syndrome law and AIDS HAART-related hyperlipidemia pathogenesis, TCM syndrome and evaluation of research and make a preliminary comparison and correlation.With methods of the epidemiological investigation and clinical practice discussing Chinese medicine's understanding on AIDS HAART-related hyperlipidemia which can provide new ideas and methods for TCM's syndrome research and treatment. (2) HAART-related hyperlipidemia usually occurs late in the course of medication, about an average of 2 to 6 years, so it often can not be paid attention to in the beginning of the treatment; Second, abnormal distribution of fat is often irreversible; and abnormal lipid metabolism is an important cause leading to cardiovascular disease; plus it may affect the therapeutic effect of HAART, so it is important to make early diagnosis and treatment. With theory of "prevention of disease" discussing correlation of syndromes of AIDS HAART-related hyperlipidemia with years of cardiovascular risk assessment, can provide an objective basis for the syndrome differentiation of TCM in order to guide clinical treatment better.3. Clinical Research(1) Counting and analyzing 366 cases of NON-AIDS patients with hyperlipidemia's epidemiological data, symptoms, signs, syndromes, years CVD risk assessment, lipids index correlation, summarizing syndromes law and its correlation with objective indicators and risk assessment of the relevance scores. Applicating SAS9.1.3 statistical software to make factor analysis and abstracting TCM syndrome factor (common factor).(2) Counting and analyzing 60 cases of AIDS patients with HAART-related hyperlipidemia's epidemiological data, symptoms, signs, syndromes, years CVD risk assessment, lipids index correlation, summarizing syndromes law and its correlation with objective indicators and risk assessment of the relevance scores. Applicating SAS9.1 statistical software to make factor analysis and abstracting TCM syndrome factor (common factor).(3) Comparing the two patient groups on the symptoms, signs and syndrome of TCM to analyze AIDS patients with HAART-related hyperlipidemia's syndromes regulation and pathogenesis further,it can provide the basis for TCM treatment of AIDS HAART-related hyperlipidemia.(4) Compare and study two patient groups on the symptoms, signs, TCM syndrome, years of CVD risk assessment and lipids index correlation applicating canonical correlation analysis, Analyze the differences and characteristics between the two groups.Results:1. Epidemiological characteristics, symptoms and syndromes(1) Epidemiological characteristicsBase on our current research, AIDS HAART-related hyperlipidemia cases, the percentage of low HDL-C hyperlipidemia is the highest (33.33%), followed by high TG hyperlipidemia (28.33%), and combined hyperlipidemia (25%); the last is high-TC hyperlipidemia (13.33%). Combined hyperlipidemia is most common in cases of primary hyperlipidemia without HIV infections, followed by high-TC hyperlipidemia, which results are different from above.Complications of AIDS HAART-related hyperlipidemia patients are fatty liver disease (FLD) in 35 cases,9 cases in hypertension, and 5 cases in coronary heart disease.Comparing with HIV uninfected cases, HIV uninfected patients with primary hyperlipidemia are mostly associate with hypertension, unlike AIDS HAART-related hyperlipidemia cases with FLD might mainly cause by the elevating in serum TG. Case studies on fat distribution in AIDS HAART-related hyperlipidemia patients, thin cheeks are the highest (58.11%), followed by abdominal circumference increased (18.92%) and limb fat meager vascular exposure (8.11%). In HIV uninfected primary hyperlipidemia patients, more then half of them don't have anomalous fat distribution. And cases in obesity, abdominal circumference increasing patients don't have the complication with centripetal fat accumulation.According to Framingham's ATP III risk assessment system (ATP Risk Estimator) for cardiovascular disease risk assessment and risk rating classification. In AIDS HAART-related hyperlipidemia patients, low-risk patients (10 years risk< 5%) 40 cases (66.67%), medium-risk cases (10 years risk 5-10%) 10 cases (16.67%), high-risk patients (CHD or CHD risk equivalents, or 10-year risk 10-15%) 5 cases (8.33%). There is no significant difference on the risk rating between HIV and non-HIV hyperlipidemia patients.(2) Symptoms and syndromesComparing 51 symptoms and syndromes from two groups of patients, AIDS HAART-related hyperlipidemia patients have 9 symptoms which frequency appears more than 40%:fatigue (76.67%), bitterness taste in mouth (50%), back pain (45%), forgetfulness (43.33%), thirst (43.33%), and distress (42.37%), pale (41.67%), weakness in waist and knee (41.67%), limb numbness (41.67%). And in HIV uninfected patients there are 9 symptoms which frequency appears more than 30%:fatigue (66.39), weakness in waist and knee (61.48%), anorexia (50%), irritability (44.81%), limb numbness (38.52%), chest tightness (37.16%), distress (36.34%), headache (32.79%), and obesity (30.6%). Symptoms appear more obviously on AIDS HAART-related hyperlipidemia patients.2.366 case studies of HIV uninfected primary hyperlipidemia patients12 common divisor were gain through factor analysis, studies show Qi stagnation with blood stasis is most common in primary hyperlipidemia patients, followed by phlegm stasis, spleen Qi deficiency syndrome, liver Qi stagnation with stagnant heat, Qi and Yin deficiency, Yin deficiency with phlegm, spleen and stomach weakness syndromes, kidney Yang deficiency, heart Qi deficiency, indicating the pathogenesis of primary hyperlipidemia is link to liver and spleen renal disorders, phlegm stagnation of blood stasis.3.66 case studies of AIDS HAART-related hyperlipidemia patientsCompare with HIV uninfected primary hyperlipidemia patients; kidney deficiency is most common in AIDS HAART-related hyperlipidemia patients. In HIV uninfected group, Qi stagnation with blood stasis is most in common, followed by phlegm stasis and spleen Qi deficiency syndrome. The syndrome distribution results show that excess Qi and blood stagnation is the main syndrome in HIV uninfected primary hyperlipidemia patients, while kidney deficiency syndrome is to AIDS HAART-related hyperlipidemia patients.4. Pathogenesis of AIDS HAART-related hyperlipidemiaAccording to syndrome distribution and literature research, the pathogenesis of AIDS HAART-related hyperlipidemia is mainly root deficiency and branch excess and mixed excess-deficient conditions. AIDS patients are mostly kidney Qi deficiency and dysfunctional in liver, kidney and spleen. Comparing with HIV uninfected primary hyperlipidemia patients; kidney deficiency is more obvious in AIDS HAART-related hyperlipidemia patients, especially with patients in the longer course treatment with HAART, significantly correlated with the degree of kidney deficiency.5. Age, BMI, cardiovascular risk score and risk classification, serum lipids and related syndromes analysisCase study between AIDS HAART-related hyperlipidemia patients and HIV uninfected primary hyperlipidemia patients on age, BMI, cardiovascular risk score and risk classification, serum lipids and TCM related syndromes analysis.The canonical correlation analysis in order to separate the two groups, the results show that HIV uninfected primary hyperlipidemia patients:X3 (10 years coronary heart disease risk assessment) and F9 (phlegm stasis), X1 (age) and Fl (Heart Qi Deficiency Syndrome) is the most relevant, and positively correlated.AIDS HAART-related hyperlipidemia patients:X4 (cardiovascular disease risk classification) and F2 (spleen phlegm obstruction factor) the maximum correlation, and a positive correlation, indicating more severe deficiency phlegm stasis of cardiovascular disease. The higher level of risk, the incidence of cardiovascular disease the greater the risk of complications.Conclusions:1. The epidemiological characteristics, symptoms and syndromes of AIDS HAART-related hyperlipidemia patients and HIV uninfected primary hyperlipidemia patients are not quite the same, maybe cause by the complex pathological changes in AIDS.2. Comparing with HIV uninfected primary hyperlipidemia patients, kidney deficiency is more obvious in AIDS HAART-related hyperlipidemia patients. In HIV uninfected group, Qi stagnation with blood stasis is most in common, followed by phlegm stasis and spleen Qi deficiency syndrome. Results reveal deficiency syndromes appear in most AIDS HAART-related hyperlipidemia patients, also indicates, treatments of Chinese medicine should emphasis on tonifying Qi to improve the treatment efficacy.3. AIDS HAART-related hyperlipidemia is root deficiency and branch excess, associate with phlegm, turbidity and stasis. AIDS patients are mostly kidney Qi deficiency and dysfunctional in liver, kidney and spleen, which are the important pathogenesis of AIDS HAART-related hyperlipidemia patients. Comparing with HIV uninfected primary hyperlipidemia patients; kidney deficiency is more obvious in AIDS HAART-related hyperlipidemia patients, especially with patients in the longer course treatment with HAART, significantly correlated with the degree of kidney deficiency. Therefore, treatments should emphasis on strengthen spleen and kidney, tonify Qi and nourishing the heart, invigorate blood and expel phlegm.4. Doctors concern more and more on the side effects of HAART treatments on AIDS patients. Hyperlipidemia has become one of the main attention, rates of cardiovascular complications have been climbing. Statins, the most effective lipid metabolism medicine, interacts with protease inhibitors. In TCM syndromes research, TCM treatments reduce the side effects of HAART, and improve the compliance of HAART while improving lipid metabolism and the life quality for patients.5. Base on factor analysis, the study on AIDS HAART-related hyperlipidemia provides an important reference value, but because of time constraints, we still need larger samples and more clinical trials in the future.
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