开始抗逆转录病毒治疗的HIV阳性西班牙裔人群中糖尿病和肥胖症的发病率以及合并症的重叠情况。
Incidence of Diabetes Mellitus and Obesity and the Overlap of Comorbidities in HIV+ Hispanics Initiating Antiretroviral Therapy.
作者信息
Gomes Angelina, Reyes Emily V, Garduno L Sergio, Rojas Rita, Mir Mesejo Geraldine, Del Rosario Eliza, Jose Lina, Javier Carmen, Vaughan Catherine, Donastorg Yeycy, Hammer Scott, Brudney Karen, Taylor Barbara S
机构信息
Department of Medicine, Columbia University Medical Center, New York, New York, United States of America.
Unidad de Tratamiento de ITS y VIH, Instituto Dermatológico y Cirugía de Piel "Dr. Humberto Bogaert Diaz", Santo Domingo, Dominican Republic.
出版信息
PLoS One. 2016 Aug 10;11(8):e0160797. doi: 10.1371/journal.pone.0160797. eCollection 2016.
BACKGROUND
Cardiovascular disease (CVD) is a leading health threat for HIV+ patients on antiretroviral therapy (ART); cardiometabolic comorbidities are key predictors of risk. Data are limited on incidence of metabolic comorbidities in HIV+ individuals initiating ART in low and middle income countries (LMICs), particularly for Hispanics. We examined incidence of diabetes and obesity in a prospective cohort of those initiating ART in the Dominican Republic.
METHODS
Participants ≥18 years, initiating ART <90 days prior to study enrollment, were examined for incidence of impaired fasting glucose (IFG), diabetes mellitus (DM), overweight, and obesity. Fasting plasma glucose (FPG) 100-125mg/dl defined IFG; FPG ≥126 mg/dl, diagnosis per medical record, or use of hypoglycemic medication defined DM. Overweight and obesity were BMI 25-30 and ≥30kg/m2, respectively. Dyslipidemia was total cholesterol ≥240mg/dl or use of lipid-lowering medication. Framingham risk equation was used to determine ten-year CVD risk at the end of observation.
RESULTS
Of 153 initiating ART, 8 (6%) had DM and 23 (16%) had IFG at baseline, 6 developed DM (28/1000 person-years follow up [PYFU]) and 46 developed IFG (329/1000 PYFU). At baseline, 24 (18%) were obese and 36 (27%) were overweight, 15 became obese (69/1000 PYFU) and 22 became overweight (163/1000 PYFU). Median observation periods for the diabetes and obesity analyses were 23.5 months and 24.3 months, respectively. Increased CVD risk (≥10% 10-year Framingham risk score) was present for 13% of the cohort; 79% of the cohort had ≥1 cardiometabolic comorbidity, 48% had ≥2, and 13% had all three.
CONCLUSIONS
In this Hispanic cohort in an LMIC, incidences of IFG/DM and overweight/obesity were similar to or higher than that found in high income countries, and cardiometabolic disorders affected three-quarters of those initiating ART. Care models incorporating cardiovascular risk reduction into HIV treatment programs are needed to prevent CVD-associated mortality in this vulnerable population.
背景
心血管疾病（CVD）是接受抗逆转录病毒治疗（ART）的HIV阳性患者面临的主要健康威胁；心脏代谢合并症是风险的关键预测因素。在低收入和中等收入国家（LMICs），尤其是西班牙裔人群中，开始接受ART治疗的HIV阳性个体发生代谢合并症的相关数据有限。我们在多米尼加共和国对一组开始接受ART治疗的前瞻性队列进行研究，以调查糖尿病和肥胖症的发病率。
方法
纳入年龄≥18岁、在研究入组前<90天开始接受ART治疗的参与者，检测其空腹血糖受损（IFG）、糖尿病（DM）、超重和肥胖症的发病率。空腹血糖（FPG）100 - 125mg/dl定义为IFG；FPG≥126mg/dl、根据病历诊断或使用降糖药物定义为DM。超重和肥胖的BMI分别为25 - 30和≥30kg/m²。血脂异常定义为总胆固醇≥240mg/dl或使用降脂药物。使用弗雷明汉风险方程在观察期末确定十年心血管疾病风险。
结果
在153名开始接受ART治疗的患者中，8例（6%）基线时患有DM，23例（16%）患有IFG，随访期间有6例发生DM（每1000人年随访[PYFU]发病率为28例），46例发生IFG（每1000 PYFU发病率为329例）。基线时，24例（18%）肥胖，36例（27%）超重，随访期间有15例变为肥胖（每1000 PYFU发病率为69例），22例变为超重（每1000 PYFU发病率为163例）。糖尿病和肥胖症分析的中位观察期分别为23.5个月和24.3个月。队列中有13%的患者心血管疾病风险增加（10年弗雷明汉风险评分≥10%）；79%的队列患者有一种以上心脏代谢合并症，48%的患者有两种以上，13%的患者三种合并症都有。
结论
在这个低收入和中等收入国家的西班牙裔队列中，IFG/DM和超重/肥胖症的发病率与高收入国家相似或更高，并且心脏代谢紊乱影响了四分之三开始接受ART治疗的患者。需要将降低心血管风险纳入HIV治疗方案的护理模式，以预防这一脆弱人群中与心血管疾病相关的死亡。
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