Putcharoen Opass, Wattanachanya Lalita, Sophonphan Jiratchaya, Siwamogsatham Sarawut, Sapsirisavat Vorapot, Gatechompol Sivaporn, Phonphithak Supalak, Kerr Stephen J, Chattranukulchai Pairoj, Avihingsanon Yingyos, Ruxrungtham Kiat, Avihingsanon Anchalee
aDivision of Infectious Disease bDivision of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Chulalongkorn University cHIV Netherlands Australia Thailand (HIV-NAT) Research Collaboration, Thai Red Cross AIDS Research Centre dDivision of Ambulatory and Hospital Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand eDepartment of Global Health, Academic Medical Center, Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, The Netherlands fDivision of Cardiovascular Medicine gDivision of Nephrology hDivision of Allergy and Immunology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
AIDS. 2017 Jul 17;31(11):1535-1543. doi: 10.1097/QAD.0000000000001496.
To determine the incidence and risk factors for developing diabetes mellitus in a cohort of Thai HIV-infected patients on long-term combination antiretroviral therapy (cART).
Prospective study conducted between July 1996 and 30 April 2015.
A total of 1748 patients (60% men) who did not have diabetes mellitus prior to ART were assessed twice a year. Incident diabetes mellitus was defined as either having two consecutive fasting glucose levels more than 126 mg/dl, or reporting antidiabetes mellitus medication/diabetes mellitus diagnosis after starting cART. Incidence rates were calculated per 1000 person-year follow-up. Multivariate Cox regression was used to determine risk factors for the development of diabetes mellitus.
During a median follow-up of 9 years (16 274 person-year of follow-up), 123 patients developed new-onset diabetes mellitus, resulting in an incidence rate of 7.6 (95% confidence interval 6.3-9) per 1000 person-year of follow-up. From the multivariate models, age more than 35 years, male sex, BMI at least 25 kg/m, family history of diabetes, abnormal waist circumference, lipodystrophy and exposure to didanosine were significantly associated with incident diabetes mellitus. The diabetes mellitus group had higher mortality rate (8.1 vs. 4.1%, P = 0.04). A significantly higher proportion diabetes vs. nondiabetes patients developed cardiovascular and cerebrovascular complications (8.9 vs. 3.6%, P = 0.008) or chronic kidney disease stage III (estimated glomerular filtration rate <60 ml/min/1.73 m) (15.3 vs. 1.9%, P < 0.001) over total follow-up.
In addition to traditional risk factors, lipodystrophy and use of didanosine were strongly associated with development of incident diabetes. Given the higher rate of cardiovascular-cerebrovascular complications and chronic kidney disease among patients with diabetes mellitus, careful assessment and appropriate management of diabetes mellitus are essential.
确定一组接受长期联合抗逆转录病毒治疗（cART）的泰国HIV感染患者中糖尿病的发病率及发病风险因素。
1996年7月至2015年4月30日进行的前瞻性研究。
共有1748例在接受抗逆转录病毒治疗前无糖尿病的患者（60%为男性），每年接受两次评估。新发糖尿病定义为连续两次空腹血糖水平超过126mg/dl，或在开始cART后报告使用抗糖尿病药物/糖尿病诊断。发病率按每1000人年随访计算。采用多变量Cox回归确定糖尿病发生的风险因素。
在中位随访9年（16274人年随访）期间，123例患者出现新发糖尿病，发病率为每1000人年随访7.6例（95%置信区间6.3 - 9）。多变量模型显示，年龄超过35岁、男性、体重指数至少25kg/m、糖尿病家族史、腰围异常、脂肪营养不良和接受去羟肌苷治疗与新发糖尿病显著相关。糖尿病组死亡率更高（8.1%对4.1%，P = 0.04）。在整个随访期间，糖尿病患者发生心血管和脑血管并发症（8.9%对3.6%，P = 0.008）或慢性肾脏病Ⅲ期（估计肾小球滤过率<60ml/min/1.73m²）（15.3%对1.9%，P < 0.001）的比例明显高于非糖尿病患者。
除传统风险因素外，脂肪营养不良和使用去羟肌苷与新发糖尿病的发生密切相关。鉴于糖尿病患者心血管 - 脑血管并发症和慢性肾脏病的发生率较高，对糖尿病进行仔细评估和适当管理至关重要。
