预测 HIV 阳性患者的短期糖尿病风险：抗 HIV 药物不良事件数据收集（D:A:D）研究。
Predicting the short-term risk of diabetes in HIV-positive patients: the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study.
机构信息
AHOD, The Kirby Institute, University of New South Wales, Sydney, Australia.
出版信息
J Int AIDS Soc. 2012 Oct 10;15(2):17426. doi: 10.7448/IAS.15.2.17426.
INTRODUCTION
HIV-positive patients receiving combination antiretroviral therapy (cART) frequently experience metabolic complications such as dyslipidemia and insulin resistance, as well as lipodystrophy, increasing the risk of cardiovascular disease (CVD) and diabetes mellitus (DM). Rates of DM and other glucose-associated disorders among HIV-positive patients have been reported to range between 2 and 14%, and in an ageing HIV-positive population, the prevalence of DM is expected to continue to increase. This study aims to develop a model to predict the short-term (six-month) risk of DM in HIV-positive populations and to compare the existing models developed in the general population.
METHODS
All patients recruited to the Data Collection on Adverse events of Anti-HIV Drugs (D:A:D) study with follow-up data, without prior DM, myocardial infarction or other CVD events and with a complete DM risk factor profile were included. Conventional risk factors identified in the general population as well as key HIV-related factors were assessed using Poisson-regression methods. Expected probabilities of DM events were also determined based on the Framingham Offspring Study DM equation. The D:A:D and Framingham equations were then assessed using an internal-external validation process; area under the receiver operating characteristic (AUROC) curve and predicted DM events were determined.
RESULTS
Of 33,308 patients, 16,632 (50%) patients were included, with 376 cases of new onset DM during 89,469 person-years (PY). Factors predictive of DM included higher glucose, body mass index (BMI) and triglyceride levels, and older age. Among HIV-related factors, recent CD4 counts of <200 cells/µL and lipodystrophy were predictive of new onset DM. The mean performance of the D:A:D and Framingham equations yielded AUROC of 0.894 (95% CI: 0.849, 0.940) and 0.877 (95% CI: 0.823, 0.932), respectively. The Framingham equation over-predicted DM events compared to D:A:D for lower glucose and lower triglycerides, and for BMI levels below 25 kg/m(2).
CONCLUSIONS
The D:A:D equation performed well in predicting the short-term onset of DM in the validation dataset and for specific subgroups provided better estimates of DM risk than the Framingham.
简介
接受联合抗逆转录病毒疗法（cART）的 HIV 阳性患者经常出现代谢并发症，如血脂异常和胰岛素抵抗，以及脂肪营养不良，增加了心血管疾病（CVD）和糖尿病（DM）的风险。据报道，HIV 阳性患者的 DM 发生率在 2%至 14%之间，在老龄化的 HIV 阳性人群中，DM 的患病率预计将继续增加。本研究旨在建立一种预测 HIV 阳性人群短期（6 个月）DM 风险的模型，并比较在普通人群中开发的现有模型。
方法
所有招募到 Data Collection on Adverse events of Anti-HIV Drugs（D:A:D）研究的患者均具有随访数据，且无既往 DM、心肌梗死或其他 CVD 事件，且具有完整的 DM 危险因素谱。使用泊松回归方法评估了普通人群中确定的常规危险因素以及关键的 HIV 相关因素。还根据 Framingham 后代研究 DM 方程确定了 DM 事件的预期概率。然后使用内部-外部验证过程评估 D:A:D 和 Framingham 方程；确定接收者操作特征（ROC）曲线下的面积（AUROC）和预测的 DM 事件。
结果
在 33308 名患者中，有 16632 名（50%）患者被纳入，89469 人年（PY）中有 376 例新发生的 DM 病例。DM 的预测因素包括血糖、体重指数（BMI）和甘油三酯水平升高以及年龄较大。在 HIV 相关因素中，最近的 CD4 计数<200 个/μL 和脂肪营养不良与新发 DM 相关。D:A:D 和 Framingham 方程的平均性能得出的 AUROC 分别为 0.894（95%CI：0.849，0.940）和 0.877（95%CI：0.823，0.932）。与 D:A:D 相比，Framingham 方程对血糖和甘油三酯较低、BMI 水平低于 25kg/m2 时，DM 事件的预测值过高。
结论
D:A:D 方程在验证数据集预测 DM 的短期发病方面表现良好，并且对于特定亚组，DM 风险的估计优于 Framingham。
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