Nephrology Division, Massachusetts General Hospital, and Harvard Medical School, Boston, MA.
Metabolism Unit, Endocrinology Division, Massachusetts General Hospital, and Harvard Medical School, Boston, MA; and.
J Acquir Immune Defic Syndr. 2023 Sep 1;94(1):53-56. doi: 10.1097/QAI.0000000000003227.
Sodium-glucose transporter 2 (SGLT2) inhibitors have been approved for treatment of diabetes mellitus (DM), chronic kidney disease, and heart failure, but little is known about prescription levels and safety profiles among people with HIV (PWH).
We leveraged data from the US Mass General Brigham electronic healthcare database to determine the use/uptake of SGLT2 inhibitors among PWH with type II diabetes (DM2) (with or without chronic kidney disease, proteinuria, or heart failure) and to assess rates of adverse events among PWH with DM2 taking SGLT2 inhibitors.
Among eligible PWH with DM2 receiving care at US Mass General Brigham (N = 907), SGLT2 inhibitors were prescribed to 8.8%. SGLT2 inhibitors were prescribed to a fraction of eligible PWH with DM2 and a concomitant diagnosis of chronic kidney disease (3.8%), proteinuria (13.2%), or heart failure (8.2%). PWH with DM2 on SGLT2 inhibitors experienced side effects (urinary tract infection, diabetic ketoacidosis, and acute kidney injury) at rates comparable with PWH with DM2 prescribed glucagon-like peptide-1 agonists. Rates of mycotic genitourinary infections were higher among those prescribed SGLT2 inhibitors (5% vs. 1%, P = 0.17), but no cases of necrotizing fasciitis ensued.
Additional studies are needed to characterize population-specific salutary and adverse effects of SGLT2 inhibitors among PWH and potentially augment prescription rates when guideline indicated.
钠-葡萄糖协同转运蛋白 2（SGLT2）抑制剂已被批准用于治疗糖尿病（DM）、慢性肾脏病和心力衰竭，但对于感染人类免疫缺陷病毒（HIV）的患者（PWH）中 SGLT2 抑制剂的处方水平和安全性概况知之甚少。
我们利用美国马萨诸塞州综合医院电子医疗数据库的数据，确定了患有 2 型糖尿病（DM2）的 PWH（无论是否患有慢性肾脏病、蛋白尿或心力衰竭）中 SGLT2 抑制剂的使用/接受情况，并评估了接受 SGLT2 抑制剂治疗的 DM2 患者中不良事件的发生率。
在接受美国马萨诸塞州综合医院治疗的合格 PWH 中（N=907），有 8.8%的患者被处方 SGLT2 抑制剂。SGLT2 抑制剂仅被处方给一小部分患有 DM2 且伴有慢性肾脏病（3.8%）、蛋白尿（13.2%）或心力衰竭（8.2%）的 PWH。接受 SGLT2 抑制剂治疗的 DM2 患者发生副作用（尿路感染、糖尿病酮症酸中毒和急性肾损伤）的比例与接受胰高血糖素样肽-1 激动剂治疗的 DM2 患者相似。接受 SGLT2 抑制剂治疗的患者中真菌性尿路感染的发生率较高（5%比 1%，P=0.17），但未发生坏死性筋膜炎。
需要进一步研究以确定 SGLT2 抑制剂在 PWH 中的特定人群有益和不良反应，并在符合指南的情况下增加处方率。
