PrayGod George, Changalucha John, Kapiga Saidi, Peck Robert, Todd Jim, Filteau Suzanne
Mwanza Research Centre, National Institute for Medical Research, Box 1462, Mwanza, Tanzania.
Mwanza Intervention Trials Unit, Mwanza, Tanzania.
BMC Infect Dis. 2017 Jan 30;17(1):103. doi: 10.1186/s12879-017-2209-z.
Data on the burden of dysglycemia among HIV-infected patients on antiretroviral therapy (ART) in Africa are limited. We determined the prevalence of pre-diabetes and diabetes among HIV-infected patients who started ART when malnourished 2 to 3 years previously and investigated the association of dysglycemia with body composition.
Malnourished (body mass index (BMI) < 18.5 kg/m) HIV-infected patients who were enrolled in the Nutritional Support for Africans Starting Antiretroviral Therapy (NUSTART) trial from 2011 to 2013 were followed-up from March to August 2015. Anthropometric, fat mass and fat-free mass by bioelectrical impedance, and C-reactive protein (CRP) data were collected at baseline and follow-up. At follow-up, we defined fasting glucose of 6.1-6.9 mmol/L as impaired fasting glucose (IFG) and 2-h oral glucose tolerance test (OGTT) glucose of ≥7.8 to <11.1 mmol/L as impaired glucose tolerance (IGT). Both of these were considered pre-diabetes. Fasting glucose of ≥7.0 mmol/L or impaired glucose tolerance of ≥11.1 mmol/L was defined as diabetes mellitus. The relation of pre-diabetes and diabetes with body composition was assessed using logistic regression.
Two hundred seventy-three (57%) of 478 patients who were alive at trial conclusion were followed-up. The mean age was 41.5 (SD 9.8) years and 65.2% (178) were females. The mean follow-up BMI was 19.9 (SD 2.8) kg/m, 12 (4.4%) were either overweight or obese, and 61 (22.3%) patients had pre-diabetes or diabetes. In multiple regression, upper tertiles of baseline hip circumference (OR: 0.41, 95% CI: 0.2, 0.8) and fat mass index (OR: 0.20 (0.1, 0.5), and upper tertiles of follow-up waist circumference (OR: 0.22 (0.1, 0.5), BMI (OR: 0.32 (0.1, 0.7), fat mass index (OR: 0.19 (0.1, 0.5) and the middle tertile of follow-up fat-free mass (OR: 0.36, 95% CI: 0.1, 0.8) were associated with lower risk of pre-diabetes and diabetes (P < 0.05 for all). Baseline and follow-up CRP were not predictors.
Low rather than high measures of adipose tissue were associated with increased risk of pre-diabetes and diabetes. Additional studies are needed to further investigate the role of body composition and control of glucose metabolism in the pathogenesis of diabetes among persons living with HIV in Africa.
非洲接受抗逆转录病毒治疗（ART）的HIV感染患者中血糖异常负担的数据有限。我们确定了2至3年前营养不良时开始接受ART的HIV感染患者中糖尿病前期和糖尿病的患病率，并调查了血糖异常与身体成分的关联。
对2011年至2013年参加非洲人启动抗逆转录病毒治疗营养支持（NUSTART）试验的营养不良（体重指数（BMI）<18.5kg/m²）HIV感染患者于2015年3月至8月进行随访。在基线和随访时收集人体测量数据、通过生物电阻抗测量的脂肪量和去脂体重，以及C反应蛋白（CRP）数据。在随访时，我们将空腹血糖6.1 - 6.9mmol/L定义为空腹血糖受损（IFG），将2小时口服葡萄糖耐量试验（OGTT）血糖≥7.8至<11.1mmol/L定义为糖耐量受损（IGT）。这两者均被视为糖尿病前期。空腹血糖≥7.0mmol/L或糖耐量受损≥11.1mmol/L被定义为糖尿病。使用逻辑回归评估糖尿病前期和糖尿病与身体成分的关系。
试验结束时存活的478例患者中有273例（57%）接受了随访。平均年龄为41.5（标准差9.8）岁，65.2%（178例）为女性。随访时的平均BMI为19.9（标准差2.8）kg/m²，12例（4.4%）超重或肥胖，61例（22.3%）患者患有糖尿病前期或糖尿病。在多元回归中，基线臀围上三分位数（比值比：0.41，95%置信区间：0.2，0.8）、脂肪量指数（比值比：0.20（0.1，0.5）），以及随访时腰围上三分位数（比值比：0.22（0.1，0.5））、BMI（比值比：0.32（0.1，0.7））、脂肪量指数（比值比：0.19（0.1，0.5））和随访时去脂体重的中三分位数（比值比：0.36，95%置信区间：0.1，0.8）与糖尿病前期和糖尿病的较低风险相关（所有P<0.05）。基线和随访时的CRP不是预测因素。
脂肪组织测量值低而非高与糖尿病前期和糖尿病风险增加相关。需要进一步研究以深入探讨身体成分和葡萄糖代谢控制在非洲HIV感染者糖尿病发病机制中的作用。
