Emory University, Atlanta, Georgia, USA.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
AIDS Res Hum Retroviruses. 2021 May;37(5):373-379. doi: 10.1089/AID.2020.0247. Epub 2021 Apr 12.
This study investigated whether the predictive ability of the Finnish Diabetes Risk Score (FINDRISC) can be improved among people with HIV by adding a marker of insulin resistance. In this longitudinal analysis of the Multicenter AIDS Cohort Study and the Women's Interagency HIV Study, HIV-positive and HIV-negative participants without prevalent diabetes were included. FINDRISC score and the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) were calculated at baseline. Cox proportional hazards models were used to examine associations between baseline risk scores and time to incident diabetes (first self-report of diabetes medication use). Model discrimination (Uno's -statistic) and calibration (observed vs. cumulative probability of diabetes) were assessed for FINDRISC, HOMA-IR, and combined FINDRISC and HOMA-IR. Overall, 2,527 men (1,299 HIV-positive and 1,228 HIV-negative, median age = 44) and 2,446 women (1,841 HIV-positive and 605 HIV-negative, median age = 41) were included. Over 47,040 person-years of follow-up, diabetes incidence rates per 1,000 person-years were 9.5 in HIV-positive men, 7.1 in HIV-negative men, 14.5 in HIV-positive women, and 15.1 in HIV-negative women. FINDRISC discrimination (HIV-positive men = 0.64 [0.55, 0.74], HIV-negative men = 0.74 [0.68, 0.79], HIV-positive women = 0.68 [0.64, 0.71], and HIV-negative women = 0.73 [0.66, 0.79]) was significantly better than that of HOMA-IR. FINDRISC was better calibrated than HOMA-IR in each of the four groups. Adding HOMA-IR did not improve FINDRISC discrimination/calibration. Diabetes risk prediction with FINDRISC was suboptimal in men and women with HIV, and its performance was not improved with addition of HOMA-IR. The optimal method for identifying people living with HIV at-risk for diabetes is yet to be identified.
本研究旨在探讨通过添加胰岛素抵抗标志物是否可以提高芬兰糖尿病风险评分（FINDRISC）在 HIV 阳性人群中的预测能力。本研究为多中心艾滋病队列研究和妇女艾滋病研究机构间合作的纵向分析，纳入了无糖尿病既往史的 HIV 阳性和 HIV 阴性参与者。在基线时计算 FINDRISC 评分和稳态模型评估的胰岛素抵抗（HOMA-IR）。使用 Cox 比例风险模型来检测基线风险评分与新发糖尿病（首次自我报告使用糖尿病药物）之间的关系。评估了 FINDRISC、HOMA-IR 以及 FINDRISC 和 HOMA-IR 联合模型的区分度（Uno 的 -统计量）和校准（观察与糖尿病累积概率）。总体而言，纳入了 2527 名男性（1299 名 HIV 阳性和 1228 名 HIV 阴性，中位年龄=44 岁）和 2446 名女性（1841 名 HIV 阳性和 605 名 HIV 阴性，中位年龄=41 岁）。在超过 47040 人年的随访期间，HIV 阳性男性的糖尿病发病率为每 1000 人年 9.5 例，HIV 阴性男性为 7.1 例，HIV 阳性女性为 14.5 例，HIV 阴性女性为 15.1 例。FINDRISC 的区分度（HIV 阳性男性=0.64 [0.55, 0.74]，HIV 阴性男性=0.74 [0.68, 0.79]，HIV 阳性女性=0.68 [0.64, 0.71]，HIV 阴性女性=0.73 [0.66, 0.79]）明显优于 HOMA-IR。在四个组中，FINDRISC 的校准均优于 HOMA-IR。添加 HOMA-IR 并未改善 FINDRISC 的区分度/校准。在 HIV 阳性男性和女性中，使用 FINDRISC 进行糖尿病风险预测的效果不佳，添加 HOMA-IR 并不能改善其性能。识别 HIV 感染者中糖尿病高危人群的最佳方法仍有待确定。
