National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America.
PLoS One. 2011;6(9):e24610. doi: 10.1371/journal.pone.0024610. Epub 2011 Sep 13.
HIV and type 2 diabetes are known risk factors for albuminuria, but no previous reports have characterized albuminuria in HIV-infected patients with diabetes.
We performed a cross-sectional study including 73 HIV-infected adults with type 2 diabetes, 82 HIV-infected non-diabetics, and 61 diabetic control subjects without HIV. Serum creatinine >1.5 mg/dL was exclusionary. Albuminuria was defined as urinary albumin/creatinine ratio >30 mg/g.
The prevalence of albuminuria was significantly increased among HIV-infected diabetics (34% vs. 13% of HIV non-diabetic vs. 16% diabetic control, p = 0.005). HIV status and diabetes remained significant predictors of albuminuria after adjusting for age, race, BMI, and blood pressure. Albumin/creatinine ratio correlated significantly with HIV viral load (r = 0.28, p = 0.0005) and HIV-infected subjects with albuminuria had significantly greater cumulative exposure to abacavir (p = 0.01). In an adjusted multivariate regression analysis of HIV-infected subjects, the diagnosis of diabetes (p = 0.003), higher HIV viral load (p = 0.03) and cumulative exposure to abacavir (p = 0.0009) were significant independent predictors of albuminuria.
HIV and diabetes appear to have additive effects on albuminuria which is also independently associated with increased exposure to abacavir and HIV viral load. Future research on the persistence, progression and management of albuminuria in this unique at-risk population is needed.
已知 HIV 和 2 型糖尿病是白蛋白尿的危险因素，但以前没有研究描述过合并糖尿病的 HIV 感染者的白蛋白尿情况。
我们进行了一项横断面研究，纳入了 73 例合并 2 型糖尿病的 HIV 感染者、82 例 HIV 感染者（非糖尿病）和 61 例无 HIV 的糖尿病对照者。血清肌酐＞1.5mg/dL 者被排除。白蛋白尿定义为尿白蛋白/肌酐比值＞30mg/g。
HIV 感染者合并糖尿病者的白蛋白尿患病率显著升高（34% vs. HIV 非糖尿病者的 13%和糖尿病对照者的 16%，p = 0.005）。在调整年龄、种族、BMI 和血压后，HIV 状态和糖尿病仍然是白蛋白尿的显著预测因素。白蛋白/肌酐比值与 HIV 病毒载量显著相关（r = 0.28，p = 0.0005），并且合并白蛋白尿的 HIV 感染者接受更久的阿巴卡韦暴露（p = 0.01）。在调整了 HIV 感染者的多变量回归分析中，糖尿病的诊断（p = 0.003）、更高的 HIV 病毒载量（p = 0.03）和累积的阿巴卡韦暴露（p = 0.0009）是白蛋白尿的独立显著预测因素。
HIV 和糖尿病似乎对白蛋白尿有相加作用，且与增加的阿巴卡韦暴露和 HIV 病毒载量独立相关。需要对这一特殊高危人群中白蛋白尿的持续存在、进展和管理进行进一步的研究。
