Tripathi A, Liese A D, Jerrell J M, Zhang J, Rizvi A A, Albrecht H, Duffus W A
Division of Internal Medicine, Department of Medicine, University of Mississippi School of Medicine, Jackson, MS, USA.
Diabet Med. 2014 Oct;31(10):1185-93. doi: 10.1111/dme.12455. Epub 2014 Apr 28.
To examine incidence density rate and correlates of incident diabetes mellitus in a cohort of HIV-infected individuals compared with matched non-HIV-infected persons.
Data were obtained from the South Carolina Medicaid system and the enhanced HIV/AIDS Reporting System surveillance database for persons ≥ 18 years of age who had been attended to during the period 1994 to 2011. Time-dependent proportional hazards analysis and marginal structural models were used to analyse the data.
A total of 13 632 individuals (6816, 1:1 matched HIV-infected and non-HIV-infected persons; median age 39 years; 57% male) contributed 88 359 person-years of follow-up. Incidence rate of diabetes was higher in the non-HIV-infected group compared with the HIV-infected group (13.60 vs. 11.35 per 1000 person-years). Multivariable hazards analysis suggested a significantly lower risk of incident diabetes among HIV-infected persons treated with combination antiretroviral therapy compared with the matched non-HIV-infected persons (adjusted hazards ratio 0.55; 95% CI 0.46-0.65). Among HIV-infected persons, marginal structural modelling suggested a significantly higher risk of diabetes with cumulative exposure to protease inhibitors over the observation period (adjusted relative risk 1.35; 95% CI 1.03-1.78), but this association was not significant for exposure to non-nucleoside reverse transcriptase inhibitors. Overall, female gender, older age, non-white race/ethnicity, and pre-existing hypertension, dyslipidaemia, obesity and hepatitis C infection were associated with higher risk of diabetes incidence.
HIV infection may not be independently associated with increased risk of diabetes. Among HIV-infected persons, exposure to protease inhibitor-based regimens may increase the risk of diabetes. Healthcare providers should make every effort to use combination antiretroviral therapy regimens with a better cardiometabolic profile.
在一组感染HIV的个体队列中，与匹配的未感染HIV的个体相比，研究糖尿病的发病密度率及其相关因素。
数据来自南卡罗来纳医疗补助系统以及1994年至2011年期间接受治疗的18岁及以上人群的强化HIV/艾滋病报告系统监测数据库。采用时间依赖性比例风险分析和边际结构模型对数据进行分析。
共有13632名个体（6816对1:1匹配的感染HIV和未感染HIV的个体；中位年龄39岁；57%为男性）提供了88359人年的随访数据。未感染HIV组的糖尿病发病率高于感染HIV组（每1000人年分别为13.60和11.35）。多变量风险分析表明，与匹配的未感染HIV的个体相比，接受联合抗逆转录病毒治疗的感染HIV个体发生糖尿病的风险显著降低（调整后的风险比为0.55；95%置信区间为0.46 - 0.65）。在感染HIV的个体中，边际结构模型表明，在观察期内累积接触蛋白酶抑制剂会显著增加患糖尿病的风险（调整后的相对风险为1.35；95%置信区间为1.03 - 1.78），但这种关联对于接触非核苷类逆转录酶抑制剂并不显著。总体而言，女性、年龄较大、非白人种族/族裔以及既往有高血压、血脂异常、肥胖和丙型肝炎感染与糖尿病发病风险较高相关。
HIV感染可能并非独立地与糖尿病风险增加相关。在感染HIV的个体中，接触基于蛋白酶抑制剂的治疗方案可能会增加患糖尿病的风险。医疗保健提供者应尽力使用具有更好心脏代谢特征的联合抗逆转录病毒治疗方案。
