亚太地区 HIV 感染者的糖尿病负担。
Diabetes mellitus burden among people living with HIV from the Asia-Pacific region.
机构信息
HIV-NAT/Thai Red Cross AIDS Research Centre, Bangkok, Thailand.
The Kirby Institute, UNSW, Sydney, Australia.
出版信息
J Int AIDS Soc. 2019 Jan;22(1):e25236. doi: 10.1002/jia2.25236.
INTRODUCTION
Comorbidities including diabetes mellitus (DM) among people living with HIV (PLHIV) are of increasing clinical concerns in combination antiretroviral therapy (cART) era. We aimed to determine the incidence and risk factors of new-onset DM among PLHIV in Asian settings.
METHODS
PLHIV from a regional observational cohort without DM prior to antiretroviral therapy (ART) initiation were included in the analysis. DM was defined as having a fasting blood glucose ≥126 mg/dL, glycated haemoglobin ≥6.5%, a two-hour plasma glucose ≥200 mg/dL, or a random plasma glucose ≥200 mg/dL. A Cox regression model, stratified by site, was used to identify risk factors associated with DM.
RESULTS AND DISCUSSION
Of the 1927 participants included, 127 were diagnosed with DM after ART initiation. Median follow-up time from ART initiation to DM diagnosis was 5.9 years (interquartile range (IQR): 2.8 to 8.9 years). The crude incidence rate of DM was 1.08 per 100 person-years (100 PYS), 95% confidence interval (CI) (0.9 to 1.3). In the multivariate analysis, later years of follow-up (2011 to 2013: HR = 2.34, 95% CI 1.14 to 4.79, p = 0.02; and 2014 to 2017: HR = 7.20, 95% CI 3.27 to 15.87, p < 0.001) compared to <2010, older age (41 to 50 years: HR = 2.46, 95% CI 1.39 to 4.36, p = 0.002; and >50 years: HR = 4.19, 95% CI 2.12 to 8.28, p < 0.001) compared to <30 years, body mass index (BMI) >30 kg/m (HR = 4.3, 95% CI 1.53 to 12.09, p = 0.006) compared to BMI <18.5 kg/m , and high blood pressure (HR = 2.05, 95% CI 1.16 to 3.63, p = 0.013) compared to those without high blood pressure, were associated with developing DM. The hazard was reduced for females (HR = 0.47, 95% CI 0.28 to 0.80, p = 0.006).
CONCLUSIONS
Type 2 DM in HIV-infected Asians was associated with later years of follow-up, high blood pressure, obesity and older age. This highlights the importance of monitoring and routine screening for non-communicable diseases including DM as PLHIV age.
简介
在联合抗逆转录病毒疗法（cART）时代，艾滋病毒（HIV）感染者（PLHIV）合并糖尿病（DM）等合并症越来越受到临床关注。我们旨在确定亚洲人群中 PLHIV 新发 DM 的发生率和危险因素。
方法
在开始抗逆转录病毒治疗（ART）之前没有 DM 的区域观察性队列中的 PLHIV 被纳入分析。DM 的定义为空腹血糖≥126mg/dL、糖化血红蛋白≥6.5%、两小时血浆葡萄糖≥200mg/dL 或随机血浆葡萄糖≥200mg/dL。采用按地点分层的 Cox 回归模型确定与 DM 相关的危险因素。
结果与讨论
在纳入的 1927 名参与者中，有 127 名在开始 ART 后被诊断为 DM。从开始 ART 到 DM 诊断的中位随访时间为 5.9 年（四分位距（IQR）：2.8 至 8.9 年）。DM 的粗发病率为 1.08 人年每 100 人年（100PYS），95%置信区间（CI）（0.9 至 1.3）。在多变量分析中，随访年限较晚（2011 年至 2013 年：HR=2.34，95%CI 1.14 至 4.79，p=0.02；2014 年至 2017 年：HR=7.20，95%CI 3.27 至 15.87，p<0.001）与<2010 年相比，年龄较大（41 至 50 岁：HR=2.46，95%CI 1.39 至 4.36，p=0.002；年龄>50 岁：HR=4.19，95%CI 2.12 至 8.28，p<0.001）与<30 岁相比，BMI>30kg/m（HR=4.3，95%CI 1.53 至 12.09，p=0.006）与 BMI<18.5kg/m 相比，以及高血压（HR=2.05，95%CI 1.16 至 3.63，p=0.013）与无高血压者相比，与发生 DM 相关。女性（HR=0.47，95%CI 0.28 至 0.80，p=0.006）发生 DM 的风险降低。
结论
亚洲 HIV 感染者 2 型 DM 与随访年限较长、高血压、肥胖和年龄较大有关。这强调了随着 PLHIV 年龄的增长，监测和常规筛查包括 DM 在内的非传染性疾病的重要性。
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