抗反转录病毒治疗过程中出现的糖尿病。

Incident diabetes in course of antiretroviral therapy.

机构信息

Infectious Disease Clinic, IRCCS Policlinico San Martino Hospital, Genoa.

Infectious Diseases Clinic, San Gerardo Hospital, University of Milano-Bicocca, Monza.

出版信息

AIDS. 2023 Jul 1;37(8):1269-1276. doi: 10.1097/QAD.0000000000003548. Epub 2023 Mar 14.

DOI:10.1097/QAD.0000000000003548

PMID:36927963

Abstract

OBJECTIVE

Recent reports of excessive weight gain in people with HIV (PWH) have raised increasing concerns on the possible increase of diabetes mellitus (DM) risk in course of integrase inhibitors (INSTIs) treatment. In this study, we aimed at describing DM incidence in course of antiretroviral therapy (ART) and identifying the factors associated with new DM onset.

DESIGN

Observational prospective SCOLTA (Surveillance Cohort Long-Term Toxicity Antiretrovirals) cohort.

METHODS

All people enrolled in SCOLTA between January 2003 and November 2021 were included. Multivariable Cox regression yielded adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for incident DM.

RESULTS

4366 PWH were included, 72.6% male, with mean age 45.6 years, and median CD4 + 460 [interquartile range (IQR) 256-710] cells/mm 3 cells/mm 3 . During the follow up, 120 incident cases of DM occurred (1.26 cases/100 person year-follow up, 95% CI 1.05-1.50).Baseline weight, but not the amount of weight gain, resulted significantly correlated to diabetes incidence (aHR by 1 kg 1.03; 95% CI 1.01-1.04), as well as older age (aHR 1.03 by 1 year; 95% CI 1.01-1.06), being ART-experienced with detectable HIV RNA at study entry (aHR 2.27, 95% CI 1.48-3.49), having untreated high blood pressure (aHR 2.90; 95% CI 1.30-6.45) and baseline blood glucose >100 mg/dl (aHR 5.47; 95% CI 3.82-7.85). Neither the INSTI class nor individual antiretrovirals were associated with an increased risk of DM.

CONCLUSIONS

Baseline weight, but not weight gain or the ART class, was associated with incident DM in this observational cohort.

摘要

目的

最近有报道称，艾滋病毒感染者（HIV 感染者）体重过度增加，这引发了人们对整合酶抑制剂（INSTI）治疗过程中糖尿病（DM）风险增加的日益关注。在这项研究中，我们旨在描述抗逆转录病毒治疗（ART）过程中 DM 的发病率，并确定与新发 DM 相关的因素。

设计

观察性前瞻性 SCOLTA（长期抗逆转录病毒毒性监测队列）队列。

方法

所有于 2003 年 1 月至 2021 年 11 月期间纳入 SCOLTA 的患者均纳入本研究。多变量 Cox 回归得出新发 DM 的调整后危险比（aHR）和 95%置信区间（CI）。

结果

共纳入 4366 名 HIV 感染者，其中 72.6%为男性，平均年龄为 45.6 岁，中位数 CD4+计数为 460[四分位间距（IQR）256-710]个细胞/mm3。在随访期间，共发生 120 例 DM 病例（1.26 例/100 人年随访，95%CI 1.05-1.50）。基线体重，但不是体重增加量，与糖尿病发病率显著相关（每增加 1kg，aHR 为 1.03；95%CI 1.01-1.04），年龄较大（每增加 1 岁，aHR 为 1.03；95%CI 1.01-1.06），研究开始时具有可检测 HIV RNA 的 ART 经验（aHR 为 2.27，95%CI 1.48-3.49），未经治疗的高血压（aHR 为 2.90；95%CI 1.30-6.45）和基线血糖>100mg/dl（aHR 为 5.47；95%CI 3.82-7.85）。INSTI 类别或个别抗逆转录病毒药物均与 DM 风险增加无关。