Samad Faizal, Harris Marianne, Puskas Cathy M, Ye Monica, Chia Jason, Chacko Sarah, Bondy Gregory P, Lima Viviane D, Montaner Julio Sg, Guillemi Silvia A
AIDS Research Program, St. Paul's Hospital, Vancouver, British Columbia, Canada.
John Ruedy Immunodeficiency Clinic, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada.
BMJ Open Diabetes Res Care. 2017 Nov 26;5(1):e000457. doi: 10.1136/bmjdrc-2017-000457. eCollection 2017.
We sought to determine the incidence and factors associated with development of diabetes mellitus (DM) in older HIV-infected individuals.
We analyzed data from people living with HIV (PLWH) ≥50 years of age enrolled in a large urban HIV outpatient clinic in Vancouver, British Columbia. Patients were categorized as having DM if they had random blood sugar ≥11.1 mmol/L, fasting blood sugar ≥7 mmol/L, HbA1C ≥6.5%, antidiabetic medication use during the follow-up period, or medical chart review confirming diagnosis of DM. We estimated the probability of developing DM, adjusting for demographic and clinical factors, using a logistic regression model.
Among 1065 PLWH followed for a median of 13 years (25th and 75th percentile (Q1-Q3): 9-18), the incidence of DM was 1.61/100 person-years follow-up. In the analysis of factors associated with new-onset DM (n=703), 88% were male, 38% had a history of injection drug use, 43% were hepatitis C coinfected, and median body mass index was 24 kg/m (Q1-Q3: 21-27). Median age at antiretroviral therapy (ART) initiation was 48 years (Q1-Q3: 43-53) and at DM diagnosis was 55 years (Q1-Q3: 50-61). Patients who started ART in 1997-1999 and had a longer exposure to older ART were at the highest risk of developing DM.
Among PLWH aged ≥50 years, the incidence of DM was 1.39 times higher than men in the general Canadian population of similar age. ART initiated in the early years of the epidemic and exposure to older ART appeared to be the main drivers of the development of DM.
我们试图确定老年HIV感染者中糖尿病（DM）的发病率及相关因素。
我们分析了不列颠哥伦比亚省温哥华一家大型城市HIV门诊所纳入的年龄≥50岁的HIV感染者（PLWH）的数据。若患者随机血糖≥11.1 mmol/L、空腹血糖≥7 mmol/L、糖化血红蛋白（HbA1C）≥6.5%、在随访期间使用抗糖尿病药物或病历审查确诊为DM，则将其归类为患有DM。我们使用逻辑回归模型估计发生DM的概率，并对人口统计学和临床因素进行校正。
在1065名PLWH中，随访时间中位数为13年（第25和第75百分位数（Q1-Q3）：9-18），DM发病率为1.61/100人年随访。在对新发DM相关因素（n = 703）的分析中，88%为男性，38%有注射吸毒史，43%合并丙型肝炎感染，体重指数中位数为24 kg/m²（Q1-Q3：21-27）。开始抗逆转录病毒治疗（ART）的年龄中位数为48岁（Q1-Q3：43-53），DM诊断时的年龄中位数为55岁（Q1-Q3：50-61）。在1997 - 1999年开始ART且接触较老ART时间较长的患者发生DM的风险最高。
在年龄≥50岁的PLWH中，DM发病率比加拿大同龄普通男性高1.39倍。在疫情早期开始的ART以及接触较老的ART似乎是DM发生的主要驱动因素。
