Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
J Acquir Immune Defic Syndr. 2010 Jun;54(2):152-9. doi: 10.1097/QAI.0b013e3181d0c911.
Opiate use is common in HIV-infected and hepatitis C virus (HCV)-infected individuals, however, its contribution to the risk of diabetes mellitus is not well understood.
Prospective study of 1713 HIV-infected and 652 HIV-uninfected participants from the Women's Interagency HIV Study between October 2000 and March 2006. Diabetes defined as fasting glucose > or =126 mg/dL, self report of diabetes medication use, or confirmed diabetes diagnosis. Opiate use determined using an interviewer-administered questionnaire. Detectable plasma HCV RNA confirmed HCV infection.
Current opiate users had a higher prevalence of diabetes (15%) than nonusers (10%, P = 0.03), and a higher risk of incident diabetes (adjusted relative hazard: 1.58, 95% confidence interval: 1.01 to 2.46), after controlling for HCV infection, HIV/antiretroviral therapy status, and diabetes risk factors including age, race/ethnicity, family history of diabetes, and body mass index. HCV infection was also an independent risk factor for diabetes (adjusted relative hazard: 1.61, 95% confidence interval: 1.02 to 2.52). HCV-infected women reporting current opiate use had the highest diabetes incidence (4.83 cases per 100 person-years).
Among women with or at-risk for HIV, opiate use is associated with increased diabetes risk independently of HCV infection. Diabetic screening should be part of care for opiate users and those infected with HCV.
阿片类药物的使用在 HIV 感染者和丙型肝炎病毒（HCV）感染者中很常见，但它对糖尿病风险的贡献尚不清楚。
2000 年 10 月至 2006 年 3 月，对妇女艾滋病研究机构间 HIV 研究中的 1713 名 HIV 感染者和 652 名 HIV 未感染者进行前瞻性研究。糖尿病的定义为空腹血糖≥126mg/dL、使用糖尿病药物的自我报告或确诊的糖尿病诊断。阿片类药物的使用通过访谈者管理的问卷确定。检测到的血浆 HCV RNA 证实 HCV 感染。
目前使用阿片类药物的患者糖尿病患病率（15%）高于非使用者（10%，P=0.03），并且在控制 HCV 感染、HIV/抗逆转录病毒治疗状况以及包括年龄、种族/族裔、糖尿病家族史和体重指数在内的糖尿病危险因素后，发生糖尿病的风险更高（调整后的相对危险：1.58，95%置信区间：1.01 至 2.46）。HCV 感染也是糖尿病的独立危险因素（调整后的相对危险：1.61，95%置信区间：1.02 至 2.52）。报告目前使用阿片类药物且感染 HCV 的 HCV 感染妇女发生糖尿病的风险最高（每 100 人年 4.83 例）。
在有或有 HIV 风险的女性中，阿片类药物的使用与糖尿病风险的增加独立相关，而与 HCV 感染无关。应将糖尿病筛查作为阿片类药物使用者和 HCV 感染者护理的一部分。
