艾滋病病毒感染者中 CD4 细胞计数最低值、宗教信仰、抗逆转录病毒治疗、2 型糖尿病发病率以及肥胖率的上升与黑非洲人有关。
Nadir CD4+, religion, antiretroviral therapy, incidence of type 2 diabetes mellitus, and increasing rates of obesity among black Africans with HIV disease.
机构信息
Department of Internal Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo;
出版信息
Int J Gen Med. 2012;5:983-90. doi: 10.2147/IJGM.S32167. Epub 2012 Nov 23.
BACKGROUND
The purpose of this study was to determine the cross-sectional association between some sociodemographic factors and antiretroviral therapy (ART), as well as the incidence and predictors of type 2 diabetes mellitus among Central Africans with human immunodeficiency virus (HIV) disease.
METHODS
This study had a cross-sectional design and was a prospective analysis of 102 patients with HIV disease (49 on ART versus 53 not on ART) in Kinshasa, Democratic Republic of Congo, between 2004 and 2008. A Cox regression model was used to assess for any relationship between type 2 diabetes and exposure to combination ART without protease inhibitors, after adjusting for known risk factors for type 2 diabetes, nadir CD4 and CD8 levels, viral load, marital status, and religion.
RESULTS
Unexpectedly elevated rates of smoking, excess alcohol intake, and ART-related total, abdominal, and peripheral obesity were observed in our study group of HIV patients. At the end of follow-up, five patients were diagnosed with type 2 diabetes (incidence rate 4.9%, 9.8 per 1000 person-years). Univariate risk factors for type 2 diabetes were male gender (relative risk [RR] 1.1, 95% confidence interval [CI] 1.01-1.4; P = 0.019), traditional religion versus new charismatic religion (RR 1.1, 95% CI 1.01-1.3; P = 0.046), exposure to ART (RR 1.1, 95% CI 1.002-1.3; P = 0.034), and single status (RR 6.2, 95% CI 1.5-15; P = 0.047). In multivariate analysis, strong significant independent predictors of type 2 diabetes were belonging to a traditional religion (HR 2.1, 95% CI 1.1-4.2; P = 0.036) and a relative increase in nadir CD4 cell count (beta coefficient 0.003; P < 0.0001).
CONCLUSION
ART-related obesity and type 2 diabetes are becoming increasing problems in Central Africans with HIV disease. A relative increase in nadir CD4 count and traditional religion status appear to be the strongest independent predictors of type 2 diabetes.
背景
本研究旨在确定一些社会人口因素与抗逆转录病毒治疗（ART）之间的横断面关联，以及中部非洲艾滋病毒（HIV）感染者中 2 型糖尿病的发病率和预测因素。
方法
本研究采用横断面设计，对 2004 年至 2008 年间刚果民主共和国金沙萨的 102 名 HIV 患者（49 名接受 ART 治疗，53 名未接受 ART 治疗）进行前瞻性分析。采用 Cox 回归模型评估在调整已知 2 型糖尿病风险因素、最低 CD4 和 CD8 水平、病毒载量、婚姻状况和宗教后，未接受蛋白酶抑制剂的联合 ART 暴露与 2 型糖尿病之间的关系。
结果
在我们的 HIV 患者研究组中，出乎意料地观察到吸烟、过量饮酒以及与 ART 相关的全身、腹部和外周肥胖率升高。在随访结束时，有 5 名患者被诊断患有 2 型糖尿病（发病率为 4.9%，每 1000 人年 9.8 例）。2 型糖尿病的单因素危险因素为男性（相对风险 [RR] 1.1，95%置信区间 [CI] 1.01-1.4；P = 0.019）、传统宗教与新魅力宗教（RR 1.1，95% CI 1.01-1.3；P = 0.046）、暴露于 ART（RR 1.1，95% CI 1.002-1.3；P = 0.034）和单身状态（RR 6.2，95% CI 1.5-15；P = 0.047）。在多变量分析中，2 型糖尿病的独立强预测因素为属于传统宗教（HR 2.1，95% CI 1.1-4.2；P = 0.036）和 CD4 细胞计数最低点相对增加（β系数 0.003；P <0.0001）。
结论
与 ART 相关的肥胖和 2 型糖尿病在中部非洲 HIV 感染者中日益成为问题。CD4 细胞计数最低点的相对增加和传统宗教状况似乎是 2 型糖尿病的最强独立预测因素。
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