Department of Biochemistry, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon.
Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon.
Curr Diab Rep. 2018 Oct 8;18(11):125. doi: 10.1007/s11892-018-1076-3.
This review seeks to address the epidemiology and pathophysiological basis of the interaction between HIV infection and diabetes and the implication for treatment. Its importance stems from the current context of the growing burden of both conditions and the possible mechanisms of interactions that may exist but not yet sufficiently examined.
HIV infection is associated with increased risk of insulin resistance, and ART is associated with metabolic derangement and the occurrence of type 2 diabetes. The increasing survival among people with HIV infection in developing countries is paralleled by a growing burden of chronic non-communicable diseases (NCDs) especially cardiovascular diseases and diabetes mellitus. The prevalence of diabetes mellitus is higher in HIV-positive persons compared to the general population, and especially those with associated hepatitis C virus (HCV) co-infection. Antiretroviral therapy (ART) during chronic HIV infection is the most incriminated risk factor for the development of diabetes mellitus through diverse mechanisms depending on the ART leading to insulin resistance and increased inflammatory status. A staggering 629 million of people 20-79 years are projected to have diabetes by 2045 while the world will soon enter the fourth decade of the HIV infection. Classical risk factors for diabetes such as physical inactivity and unhealthy diet may not solely explain the current trends, suggesting the role of novel risk factors including infections/inflammation. HIV and its treatment have been identified as potential contributors. Co-infections frequently observed during HIV infection also significantly influence both the epidemiological and pathophysiological of the link between HIV and diabetes. Although the relative contribution of each risk factor has not yet been quantified, several lines of evidence suggest that ART is a major contributor to hyperglycemia in HIV infection. ARTs have also led to an increase in metabolic dysfunction, including insulin resistance syndromes, dyslipidemia, and lipodystrophy. The association between ARTs and the risk of developing diabetes therefore calls for a careful choice of medication and evaluation of the risk of developing diabetes.
本综述旨在探讨 HIV 感染与糖尿病相互作用的流行病学和病理生理学基础及其治疗意义。其重要性源于目前这两种疾病负担不断增加的背景，以及可能存在但尚未充分研究的相互作用机制。
HIV 感染与胰岛素抵抗风险增加相关，抗逆转录病毒治疗（ART）与代谢紊乱和 2 型糖尿病的发生相关。发展中国家 HIV 感染者的生存状况不断改善，同时慢性非传染性疾病（NCDs）的负担也在不断增加，尤其是心血管疾病和糖尿病。与一般人群相比，HIV 阳性者，尤其是合并丙型肝炎病毒（HCV）感染的患者，糖尿病的患病率更高。慢性 HIV 感染期间的抗逆转录病毒治疗（ART）是通过多种机制导致糖尿病发展的最主要危险因素，这些机制取决于导致胰岛素抵抗和炎症状态增加的 ART。预计到 2045 年，全球将有 6.29 亿 20-79 岁的人患有糖尿病，而世界即将进入 HIV 感染的第四个十年。目前的流行趋势不能仅用糖尿病的传统危险因素（如缺乏运动和不健康饮食）来解释，这表明包括感染/炎症在内的新型危险因素可能发挥了作用。HIV 及其治疗已被确定为潜在的致病因素。HIV 感染时经常发生的合并感染也显著影响了 HIV 与糖尿病之间关联的流行病学和病理生理学。虽然每种危险因素的相对贡献尚未量化，但有几条证据表明，ART 是 HIV 感染中导致高血糖的主要因素。ART 还导致代谢功能障碍增加，包括胰岛素抵抗综合征、血脂异常和脂肪营养不良。因此，ART 与发生糖尿病的风险之间存在关联，这需要仔细选择药物并评估发生糖尿病的风险。
