Department of Infectious Diseases, Inflammation Center, Helsinki University Hospital, Helsinki, Finland.
University of Helsinki, Helsinki, Finland.
HIV Med. 2021 Apr;22(4):244-253. doi: 10.1111/hiv.13009. Epub 2020 Nov 9.
Comparative data on glucose disorders using fasting blood samples between people living with HIV (PLWH) and the general population are lacking. The objective of this study was to compare the prevalence and risk factors of obesity and disturbances in glucose homeostasis between PLWH treated with modern antiretroviral therapy and the general population.
Adjusted prevalence of obesity, features of insulin resistance (triglyceride:high-density lipoprotein cholesterol ratio and alanine aminotransferase), impaired fasting glucose (IFG), diabetes mellitus (DM) and combined dysglycaemia (presence of IFG or DM) were determined using fasting blood samples among 1041 PLWH and 7047 subjects representing the general population.
People living with HIV had a lower prevalence of obesity [18.2%, 95% confidence interval (CI): 15.1-21.2 vs. 23.9%, 95% CI: 22.4-25.4], but a higher prevalence of insulin resistance and IFG (20.0%, 95% CI: 16.6-23.4 vs. 9.8%, 95% CI: 8.7-10.8) than the general population. Fasting glucose concentration was higher, but glycated haemoglobin (HbA1c) was lower, among PLWH. Prevalence of dysglycaemia for a given body mass index (BMI) was higher in PLWH than in the general population. The prevalence of DM did not differ between PLWH (13.2%, 95% CI: 10.2-15.9) and the general population (14.5%, 95% CI: 13.6-15.4).
The prevalence of obesity was lower, but the risk of dysglycaemia for a given BMI was significantly higher, among PLWH, highlighting the importance of prevention and treatment of obesity among HIV-infected subjects. Regardless of the increased prevalence of insulin resistance and IFG, DM was surprisingly not more common among PLWH, raising concern about the under-diagnosis of DM, possibly due to low sensitivity of HbA1c in this patient population.
目前缺乏使用空腹血样比较 HIV 感染者（PLWH）和普通人群葡萄糖代谢紊乱的相关数据。本研究旨在比较接受现代抗逆转录病毒治疗的 PLWH 和普通人群中肥胖和葡萄糖稳态紊乱的流行率及其相关因素。
采用空腹血样，比较了 1041 例 PLWH 和 7047 名普通人群中肥胖（调整后流行率，95%置信区间（CI）：15.1-21.2%比 23.9%，95%CI：22.4-25.4%）、胰岛素抵抗（甘油三酯/高密度脂蛋白胆固醇比值和丙氨酸氨基转移酶）、空腹血糖受损（IFG）、糖尿病（DM）和联合糖代谢异常（IFG 或 DM 并存）的流行率。
PLWH 的肥胖流行率较低（18.2%，95%CI：15.1-21.2%比 23.9%，95%CI：22.4-25.4%），但胰岛素抵抗和 IFG 的流行率较高（20.0%，95%CI：16.6-23.4%比 9.8%，95%CI：8.7-10.8%）。与普通人群相比，PLWH 的空腹血糖浓度较高，但糖化血红蛋白（HbA1c）较低。对于给定的体重指数（BMI），PLWH 的糖代谢异常流行率高于普通人群。PLWH（13.2%，95%CI：10.2-15.9）和普通人群（14.5%，95%CI：13.6-15.4）的 DM 流行率无差异。
PLWH 的肥胖流行率较低，但对于给定的 BMI，糖代谢异常的风险显著更高，这突显了在 HIV 感染人群中预防和治疗肥胖的重要性。尽管胰岛素抵抗和 IFG 的流行率增加，但 PLWH 中 DM 并不更为常见，这令人担忧，可能是由于该患者人群中 HbA1c 的敏感性较低，导致 DM 的诊断不足。
