Division of Infectious Diseases, Department of Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, 3rd Floor, Silverstein Building, Ste. E, Philadelphia, PA 19104, USA.
AIDS. 2012 Oct 23;26(16):2087-95. doi: 10.1097/QAD.0b013e328359a8e5.
Type 2 diabetes (DM2) is increasingly common in HIV-infected individuals. Antiretroviral agents and chronic inflammation may adversely affect glycemic control. However, little is known about the effectiveness of diabetic medical therapy in HIV-infected patients. The objective of this study was to compare the effectiveness of initial diabetic medical therapy in patients with and without HIV infection.
A retrospective cohort study was conducted among adults with DM2 initiating diabetic medications within the Centers for AIDS Research Network of Integrated Clinical Systems cohort.
Generalized estimating equations were used to compare changes in hemoglobin A1c (HbA1c) through the year after initiation of therapy, controlling for baseline HbA1c and demographic and clinical covariates.
Two hundred and eighty-six HIV-infected patients and 858 age and sex-matched HIV-uninfected patients initiated diabetic medications during the study period. Overall, patients had an adjusted absolute mean reduction in HbA1c of 1.04% [95% confidence interval (CI) -0.87 to -1.22] during the first year of therapy. HIV-infected patients achieved significantly smaller reductions in HbA1c, with an absolute mean difference of -0.17% (95% CI -0.28 to -0.06; P = 0.003). On subanalyses, HIV-infected patients on a protease inhibitor-based regimen had significantly smaller reductions in HbA1c compared to HIV-uninfected patients (adjusted absolute difference -0.21%, 95% CI -0.35 to -0.08; P = 0.002).
Patients with HIV infection who initiate diabetic medical therapy achieve smaller reductions in HbA1c than patients without HIV infection in the course of routine clinical care. This less robust response may in part be related to use of antiretrovirals that exacerbate insulin resistance, specifically protease inhibitors.
2 型糖尿病（DM2）在感染 HIV 的人群中越来越常见。抗逆转录病毒药物和慢性炎症可能会对血糖控制产生不利影响。然而，对于 HIV 感染患者的糖尿病药物治疗的有效性知之甚少。本研究的目的是比较有和没有 HIV 感染的患者初始糖尿病药物治疗的效果。
在艾滋病研究网络综合临床系统队列中，对开始使用糖尿病药物的 DM2 成年患者进行回顾性队列研究。
使用广义估计方程比较治疗开始后一年内血红蛋白 A1c（HbA1c）的变化，控制基线 HbA1c 和人口统计学及临床协变量。
在研究期间，286 例 HIV 感染患者和 858 例年龄和性别匹配的 HIV 未感染患者开始使用糖尿病药物。总体而言，患者在治疗的第一年HbA1c 的平均绝对降幅为 1.04%（95%置信区间 -0.87 至 -1.22）。HIV 感染患者的 HbA1c 降幅明显较小，平均绝对差值为 -0.17%（95%置信区间 -0.28 至 -0.06；P = 0.003）。在亚分析中，与 HIV 未感染患者相比，基于蛋白酶抑制剂方案的 HIV 感染患者的 HbA1c 降幅明显较小（调整后的绝对差值 -0.21%，95%置信区间 -0.35 至 -0.08；P = 0.002）。
在常规临床护理过程中，开始接受糖尿病药物治疗的 HIV 感染患者的 HbA1c 降低幅度小于没有 HIV 感染的患者。这种反应不那么强烈的部分原因可能与使用会加剧胰岛素抵抗的抗逆转录病毒药物有关，特别是蛋白酶抑制剂。
