Spagnuolo Vincenzo, Galli Laura, Poli Andrea, Salpietro Stefania, Gianotti Nicola, Piatti Piermarco, Cossarini Francesca, Vinci Concetta, Carini Elisabetta, Lazzarin Adriano, Castagna Antonella
Department of Infectious Diseases, San Raffaele Scientific Institute, via Stamira d'Ancona 20, 20127, Milan, Italy.
Università Vita-Salute San Raffaele, Milan, Italy.
BMC Infect Dis. 2017 Jan 7;17(1):43. doi: 10.1186/s12879-016-2099-5.
Statin use is associated with a modest increase in the incidence of type 2 diabetes mellitus (DM) among the general population. However, HIV-infected patients have a higher risk of developing DM, and it is unclear whether statins have a diabetogenic effect in these patients. Therefore, we investigated the associations of statin use and exposure to antiretroviral drugs with type 2 DM onset in a cohort of HIV-infected patients.
This retrospective, controlled, cohort study identified HIV-1-infected patients who did not have DM and were not receiving statins at their antiretroviral treatment (ART) initiation. Follow-up was accrued from ART initiation to the earliest instance of a DM diagnosis, loss to follow-up, death, or last available visit. The incidence of DM was estimated according to statin use, which was adjusted for periods without statin treatment. The Fine-Gray competing risk model was used in the multivariate analysis to identify risk factors for developing DM.
The analyses evaluated 6,195 patients followed for 9.8 years (interquartile range: 4.3-16.3 years). During 64,149 person-years of follow-up (PYFU), 235 patients developed DM (crude incidence: 3.66 [95%CI: 3.20-4.13] per 1,000 PYFU), and 917 (14%) patients used statins. After adjusting for potential confounders, statin use was associated with a non-significant increase in the risk of DM (AHR: 1.21, 95% CI: 0.71-2.07; P = 0.47). DM was more likely among patients who were ever treated with stavudine, and less likely among those ever treated using emtricitabine, tenofovir, abacavir, efavirenz, nevirapine, atazanavir or darunavir.
A higher risk of diabetes mellitus was not associated with statin treatment but with traditional risk factors and stavudine use while a reduced risk of DM was associated with the use of emtricitabine, tenofovir, abacavir, efavirenz, nevirapine, atazanavir or darunavir.
在普通人群中，使用他汀类药物与2型糖尿病（DM）发病率的适度增加有关。然而，感染人类免疫缺陷病毒（HIV）的患者患DM的风险更高，尚不清楚他汀类药物在这些患者中是否具有致糖尿病作用。因此，我们在一组HIV感染患者中研究了他汀类药物的使用以及抗逆转录病毒药物暴露与2型DM发病之间的关联。
这项回顾性、对照队列研究纳入了在开始抗逆转录病毒治疗（ART）时未患DM且未接受他汀类药物治疗的HIV-1感染患者。随访从ART开始至DM诊断、失访、死亡或最后一次可获得的就诊的最早时间。根据他汀类药物的使用情况估计DM的发病率，并对未使用他汀类药物治疗的时间段进行调整。多变量分析中使用Fine-Gray竞争风险模型来确定发生DM的危险因素。
分析评估了6195例患者，随访9.8年（四分位间距：4.3 - 16.3年）。在64149人年的随访期（PYFU）内，235例患者发生DM（粗发病率：每1000 PYFU为3.66 [95%CI：3.20 - 4.13]），917例（14%）患者使用他汀类药物。在调整潜在混杂因素后，他汀类药物的使用与DM风险的非显著性增加相关（调整后风险比：1.21，95%CI：0.71 - 2.07；P = 0.47）。曾接受司他夫定治疗的患者发生DM的可能性更大，而曾使用恩曲他滨、替诺福韦、阿巴卡韦、依非韦伦、奈韦拉平、阿扎那韦或达芦那韦治疗的患者发生DM的可能性较小。
糖尿病的较高风险与他汀类药物治疗无关，而是与传统危险因素和司他夫定的使用有关，而DM风险的降低与恩曲他滨、替诺福韦、阿巴卡韦、依非韦伦、奈韦拉平、阿扎那韦或达芦那韦的使用有关。
