随着时间的推移，HIV 感染青少年的胰岛素敏感性变化及其相关因素。
Changes in insulin sensitivity over time and associated factors in HIV-infected adolescents.
机构信息
Department of Pediatrics, The Saban Research Institute of Children's Hospital Los Angeles, Los Angeles, California.
Department of Epidemiology, Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
出版信息
AIDS. 2018 Mar 13;32(5):613-622. doi: 10.1097/QAD.0000000000001731.
OBJECTIVE
To compare prevalence of insulin resistance between perinatally HIV-infected (PHIV+) and perinatally HIV-exposed, but uninfected adolescents (PHEU), determine incidence of and contributory factors to new and resolved cases of insulin resistance in PHIV+, and evaluate glucose metabolism.
DESIGN
Cross-sectional design for comparison of prevalence among PHIV+ and PHEU. Longitudinal design for incidence and resolution of insulin resistance among PHIV+ at risk for these outcomes.
METHODS
The source population was adolescents from pediatric HIV clinics in the United States and Puerto Rico participating in the Pediatric HIV/AIDS Cohort Study, an ongoing prospective cohort study designed to evaluate impact of HIV infection and its treatment on multiple domains in preadolescents and adolescents. Insulin resistance was assessed by homeostatic model assessment of insulin resistance. Those with incident insulin resistance underwent 2-h oral glucose tolerance test and HbA1c. Baseline demographic, metabolic, and HIV-specific variables were evaluated for association with incident or resolved insulin resistance.
RESULTS
Unadjusted prevalence of insulin resistance in PHIV+ was 27.3 versus 34.1% in PHEU. After adjustment for Tanner stage, age, sex, and race/ethnicity, there was no significant difference between groups. Factors positively associated with developing insulin resistance included female sex, higher BMI z score, and higher waist circumference; those associated with resolving insulin resistance included male sex and lower BMI z score.
CONCLUSION
Prevalence of insulin resistance in PHIV+ and PHEU was substantially higher than that reported in HIV-uninfected nonoverweight youth, but similar to that in HIV-uninfected obese youth. Factors associated with incident or resolved insulin resistance among PHIV+ were similar to those reported in HIV-negative obese youth. However, a contributory role of HIV infection and/or its treatment to the incident risk of insulin resistance cannot be excluded.
目的
比较围生期感染 HIV（PHIV+）和围生期暴露但未感染 HIV 的青少年（PHEU）之间的胰岛素抵抗发生率，确定 PHIV+中新发和已缓解胰岛素抵抗的发生率和促成因素，并评估葡萄糖代谢情况。
设计
PHIV+和 PHEU 之间流行率比较的横断面设计。PHIV+发生和缓解胰岛素抵抗的纵向设计，这些患者有发生这些结局的风险。
方法
研究对象来自美国和波多黎各儿科 HIV 诊所的儿科 HIV/AIDS 队列研究中的青少年，这是一项正在进行的前瞻性队列研究，旨在评估 HIV 感染及其治疗对青春期前和青少年多个领域的影响。胰岛素抵抗通过稳态模型评估的胰岛素抵抗进行评估。新发胰岛素抵抗患者行 2 小时口服葡萄糖耐量试验和糖化血红蛋白检测。评估基线人口统计学、代谢和 HIV 特异性变量与新发或缓解胰岛素抵抗的相关性。
结果
未调整的 PHIV+胰岛素抵抗发生率为 27.3%，而 PHEU 为 34.1%。调整了 Tanner 分期、年龄、性别和种族/民族后，两组之间无显著差异。与发生胰岛素抵抗相关的因素包括女性、更高的 BMI z 评分和更高的腰围；与胰岛素抵抗缓解相关的因素包括男性和更低的 BMI z 评分。
结论
PHIV+和 PHEU 的胰岛素抵抗发生率明显高于未感染 HIV 的非超重青少年，但与未感染 HIV 的肥胖青少年相似。与 PHIV+新发或缓解胰岛素抵抗相关的因素与 HIV 阴性肥胖青少年相似。然而，不能排除 HIV 感染及其治疗对胰岛素抵抗发生风险的促成作用。
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