Abelman Rebecca A, Schneider Michael F, Cox Christopher, Messerlian Geralyn, Cohen Mardge, Gustafson Deborah, Plankey Michael, Sharma Anjali, Price Jennifer, Grunfeld Carl, Tien Phyllis C
Department of Medicine, University of California San Francisco, San Francisco, CA.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
J Acquir Immune Defic Syndr. 2024 Apr 15;95(5):486-493. doi: 10.1097/QAI.0000000000003380.
HIV is associated with alterations in androgen hormone levels and sex hormone-binding globulin (SHBG) in women. Higher SHBG has been associated with a lower risk of diabetes in the general population, but the contribution of HIV, androgen hormones, SHBG, and menopausal phase to diabetes is unclear.
From April 2003 through February 2020, 896 women with HIV (WWH) and 343 women without HIV (WWOH) from the Women's Interagency HIV Study with morning total testosterone, dehydroepiandrosterone sulfate (DHEAS), and SHBG levels were followed to assess for incident diabetes. Parametric regression models were used with age as the time scale and relative times (RT) as the measure of association of hormone level and menopausal phase with incident diabetes. Analyses incorporated time-dependent androgen hormone, SHBG levels, and menopausal phase and were adjusted for race/ethnicity, enrollment year, smoking status, BMI, hepatitis C virus status, and HIV-related factors.
In total, 128 (14%) WWH and 47 (14%) WWOH developed diabetes. In WWH, a doubling of SHBG and DHEAS were associated with a 7% (RT = 1.07 [95% CI: 0.82 to 1.40] and 15% (RT = 1.15 [95% CI: 0.95 to 1.39]) longer time to diabetes, respectively; in WWOH, a doubling of SHBG and DHEAS were associated with 84% (RT = 1.84 [95% CI: 0.89 to 3.82]) and 41% (RT= 1.41 [95% CI: 0.82 to 2.44]) longer times to diabetes. Total testosterone was not associated. In WWH, later menopausal phase was associated with shorter times to diabetes.
Despite alterations in androgen hormone and SHBG levels in HIV, regardless of HIV status, higher SHBG and DHEAS were associated with nonstatistically significant slower progression to diabetes. The menopausal transition may be a better hormonal indicator of diabetes risk in WWH.
HIV与女性雄激素水平和性激素结合球蛋白（SHBG）的改变有关。在普通人群中，较高的SHBG与较低的糖尿病风险相关，但HIV、雄激素、SHBG和绝经阶段对糖尿病的影响尚不清楚。
从2003年4月至2020年2月，对来自女性机构间HIV研究的896名感染HIV的女性（WWH）和343名未感染HIV的女性（WWOH）进行随访，检测其清晨总睾酮、硫酸脱氢表雄酮（DHEAS）和SHBG水平，以评估糖尿病的发病情况。使用参数回归模型，以年龄为时间尺度，相对时间（RT）作为激素水平和绝经阶段与糖尿病发病关联的度量。分析纳入了随时间变化的雄激素、SHBG水平和绝经阶段，并对种族/族裔、入组年份、吸烟状况、体重指数、丙型肝炎病毒感染状况和HIV相关因素进行了调整。
共有128名（14%）WWH和47名（14%）WWOH患糖尿病。在WWH中，SHBG和DHEAS翻倍分别与糖尿病发病时间延长7%（RT = 1.07 [95% CI：0.82至1.40]）和15%（RT = 1.15 [95% CI：0.
