Butt Adeel A, Fultz Shawn L, Kwoh C Kent, Kelley David, Skanderson Melissa, Justice Amy C
Division of Infectious Diseases, University of Pittsburgh School of Medicine, and VA Pittsburgh Healthcare System, PA, USA.
Hepatology. 2004 Jul;40(1):115-9. doi: 10.1002/hep.20289.
We examined the association of hepatitis C virus (HCV) infection with diabetes in veterans infected with human immunodeficiency virus (HIV) before and after the institution of highly active antiretroviral therapy (HAART). The role of age, race, liver disease, alcohol, and drug diagnoses upon the risk of diabetes was also determined. Male veterans with HIV who entered care between 1992 and 2001 were identified from the Veterans Affairs (VA) administrative database. Demographic and disease data were extracted. Kaplan-Meier curves were plotted to determine the incidence of diabetes. Unadjusted and adjusted hazards ratios for diabetes were determined using Cox regression method. A total of 26,988 veterans were studied. In multivariate Cox regression analysis, factors associated with a diagnosis of diabetes included increasing age (HR, 1.44 per 10-year increase in age; 95% CI, 1.39-1.49), minority race (African American: HR, 1.35; 95% CI, 1.24-1.48; Hispanic: HR, 1.63; 95% CI, 1.43-1.86), and care in the HAART era (HR, 2.35; 95% CI, 2.01-2.75). There was a significant interaction between care in the HAART era and HCV infection, with HCV infection being associated with a significant risk of diabetes in the HAART era (HR, 1.39; 95% CI, 1.27-1.53) but not in the pre-HAART era (HR, 1.01; 95% CI, 0.75-1.36). In conclusion, HIV-infected veterans in the HAART era are at a higher risk for diabetes compared with those in the pre-HAART era. HCV coinfection is associated with a significantly higher risk of diabetes in the HAART era, but not in the pre-HAART era. HCV-HIV coinfected patients should be aggressively screened for diabetes.
我们研究了在高效抗逆转录病毒治疗（HAART）实施前后，丙型肝炎病毒（HCV）感染与感染人类免疫缺陷病毒（HIV）的退伍军人患糖尿病之间的关联。还确定了年龄、种族、肝脏疾病、酒精和药物诊断对糖尿病风险的作用。从退伍军人事务部（VA）行政数据库中识别出1992年至2001年间开始接受治疗的感染HIV的男性退伍军人。提取了人口统计学和疾病数据。绘制了Kaplan-Meier曲线以确定糖尿病的发病率。使用Cox回归方法确定糖尿病的未调整和调整后的风险比。总共研究了26988名退伍军人。在多变量Cox回归分析中，与糖尿病诊断相关的因素包括年龄增加（每增加10岁，风险比为1.44；95%置信区间为1.39 - 1.49）、少数族裔（非裔美国人：风险比为1.35；95%置信区间为1.24 - 1.48；西班牙裔：风险比为1.63；95%置信区间为1.43 - 1.86）以及在HAART时代接受治疗（风险比为2.35；95%置信区间为2.01 - 2.75）。在HAART时代接受治疗与HCV感染之间存在显著的交互作用，在HAART时代HCV感染与糖尿病的显著风险相关（风险比为1.39；95%置信区间为1.27 - 1.53），但在HAART时代之前则不然（风险比为1.01；95%置信区间为0.75 - 1.36）。总之，与HAART时代之前相比，HAART时代感染HIV的退伍军人患糖尿病的风险更高。在HAART时代，HCV合并感染与糖尿病的显著更高风险相关，但在HAART时代之前并非如此。HCV - HIV合并感染的患者应积极筛查糖尿病。
