Kyaw Nang Thu Thu, Satyanarayana Srinath, Oo Htun Nyunt, Kumar Ajay M V, Harries Anthony D, Aung Si Thu, Kyaw Khine Wut Yee, Phyo Khaing Hnin, Aung Thet Ko, Magee Matthew J
Center for Operational Research, International Union Against Tuberculosis and Lung Disease, The Union Myanmar Office, Mandalay, Myanmar.
Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University, Atlanta, Georgia.
Open Forum Infect Dis. 2018 Dec 28;6(1):ofy355. doi: 10.1093/ofid/ofy355. eCollection 2019 Jan.
There is limited empirical evidence on the relationship between hyperglycemia, tuberculosis (TB) comorbidity, and mortality in the context of HIV. We assessed whether hyperglycemia at enrollment in HIV care was associated with increased risk of all-cause mortality and whether this relationship was different among patients with and without TB disease.
We conducted a retrospective analysis of adult (≥15 years) HIV-positive patients enrolled into HIV care between 2011 and 2016 who had random blood glucose (RBG) measurements at enrollment. We used hazards regression to estimate associations between RBG and rate of all-cause mortality.
Of 25 851 patients, 43% were female, and the median age was 36 years. At registration, the median CD4 count (interquartile range [IQR]) was 162 (68-310) cell/mm, the median RBG level (IQR) was 88 (75-106) mg/dL, and 6.2% (95% confidence interval [CI], 6.0%-6.5%) had hyperglycemia (RBG ≥140 mg/dL). Overall 29% of patients had TB disease, and 15% died during the study period. The adjusted hazard of death among patients with hyperglycemia was significantly higher (adjusted hazard ratio [aHR], 1.2; 95% CI, 1.1-1.4) than among those with normoglycemia without TB disease, but not among patients with TB disease (aHR, 1.0; 95% CI, 0.8-1.2). Using 4 categories of RBG and restricted cubic spline regression, aHRs for death were significantly increased in patients with RBG of 110-140 mg/dL (categorical model: aHR, 1.3; 95% CI, 1.2-1.4; restricted spline: aHR, 1.1; 95% CI, 1.0-1.1) compared with those with RBG <110 mg/dL.
Our findings highlight an urgent need to evaluate hyperglycemia screening and diagnostic algorithms and to ultimately establish glycemic targets for PLHIV with and without TB disease.
关于高血糖、结核病合并感染与艾滋病病毒（HIV）感染情况下死亡率之间的关系，实证证据有限。我们评估了HIV护理登记时的高血糖是否与全因死亡率风险增加相关，以及这种关系在患有和未患有结核病的患者中是否有所不同。
我们对2011年至2016年期间登记接受HIV护理的成年（≥15岁）HIV阳性患者进行了回顾性分析，这些患者在登记时进行了随机血糖（RBG）测量。我们使用风险回归来估计RBG与全因死亡率之间的关联。
在25851名患者中，43%为女性，中位年龄为36岁。登记时，CD4细胞计数中位数（四分位间距[IQR]）为162（68 - 310）个细胞/mm³，RBG水平中位数（IQR）为88（75 - 106）mg/dL，6.2%（95%置信区间[CI]，6.0% - 6.5%）患有高血糖（RBG≥140 mg/dL）。总体而言，29%的患者患有结核病，15%的患者在研究期间死亡。高血糖患者的调整后死亡风险显著高于无结核病的血糖正常患者（调整后风险比[aHR]，1.2；95% CI，1.1 - 1.4），但在患有结核病的患者中并非如此（aHR，1.0；95% CI，0.8 - 1.2）。使用4类RBG和受限立方样条回归分析，与RBG<110 mg/dL的患者相比，RBG为110 - 140 mg/dL的患者死亡的aHR显著增加（分类模型：aHR，1.3；95% CI，1.2 - 1.4；受限样条：aHR，1.1；95% CI，1.0 - 1.1）。
我们的研究结果凸显了迫切需要评估高血糖筛查和诊断算法，并最终为患有和未患有结核病的HIV感染者确定血糖目标。
