糖尿病对 HIV 病毒学控制的影响：MACS/WIHS 联合队列研究的结果。
The impact of diabetes mellitus on HIV virologic control: results of the MACS/WIHS combined cohort study.
机构信息
University of Colorado Anschutz Medical Campus, Aurora, CO.
John Hopkins University, Baltimore, MD.
出版信息
AIDS. 2024 Nov 15;38(14):1922-1931. doi: 10.1097/QAD.0000000000003978. Epub 2024 Jul 18.
OBJECTIVE
Diabetes mellitus (DM) is associated with lower antiretroviral (ART) drug exposure among persons with HIV (PWH) compared to PWH without DM. The association between DM and virologic control in PWH, however, remains unknown.
METHODS
We included participants in the Multicenter AIDS Cohort Study/Women's Interagency HIV Study Combined Cohort Study (MWCCS) who had initiated ART between 1999 and 2020 and had a suppressed HIV viral load (≤200 copies/ml) within 1 year of ART initiation. We compared the frequency of incident HIV viremia (HIV-1 RNA >200 copies/ml) between adult PWH with and without DM. Poisson regression was used to examine the rate of incident viremia based on the diagnosis of DM among PWH. DM was defined as two consecutive fasting glucose measurements ≥126 mg/dl, use of antidiabetic medications, preexisting DM diagnosis, or a confirmed HbA1c >6.5%.
RESULTS
1061 women (112 with DM, 949 without DM) and 633 men (41 with DM, and 592 without DM) were included in the analysis. The relative rate (RR) of incident HIV viremia for women with HIV and DM was lower when compared to women without DM (0.85 [95% CI: 0.72-0.99]; P = 0.04). The RR of incident viremia for women with uncontrolled DM (HbA1c > 7.5%) was higher when compared to women with controlled DM (HbA1c < 7.5%) (1.46 [95% CI: 1.03-2.07]; P = 0.03). In contrast, the RR of incident viremia for men with HIV and DM was not statistically different compared to men without DM (1.2 [95% CI: 0.96-1.50]; P = 0.12). The results were stratified by adherence levels (100%, 95-99%, and <95% based on self-report).
CONCLUSIONS
Women with DM who are highly adherent to ART (100% self-reported adherence) have a lower risk of viremia compared to women with HIV without DM. However, women with poorly controlled DM were at higher risk of HIV viremia than women with controlled DM. Further research is necessary to understand the impact of sex, DM, and ART adherence on HIV viremia.
目的
与无糖尿病（DM）的 HIV 感染者（PWH）相比，DM 患者的抗逆转录病毒（ART）药物暴露水平较低。然而，DM 与 PWH 病毒学控制之间的关联尚不清楚。
方法
我们纳入了 1999 年至 2020 年间接受 ART 治疗且 ART 治疗启动后 1 年内 HIV 病毒载量（HIV-1 RNA）得到抑制（≤200 拷贝/ml）的多中心 AIDS 队列研究/妇女艾滋病研究机构间 HIV 联合队列研究（MWCCS）参与者。我们比较了 DM 与无 DM 的 PWH 中新发 HIV 血症（HIV-1 RNA >200 拷贝/ml）的发生率。基于 PWH 中 DM 的诊断，泊松回归分析了新发病毒血症的发生率。DM 定义为两次连续空腹血糖测量≥126mg/dl、使用抗糖尿病药物、预先存在的 DM 诊断或证实 HbA1c >6.5%。
结果
在分析中纳入了 1061 名女性（112 名患有 DM，949 名未患有 DM）和 633 名男性（41 名患有 DM，592 名未患有 DM）。与无 DM 的女性相比，患有 HIV 和 DM 的女性新发 HIV 血症的相对危险度（RR）较低（0.85 [95%CI：0.72-0.99]；P=0.04）。与 DM 控制良好（HbA1c <7.5%）的女性相比，DM 控制不佳（HbA1c >7.5%）的女性新发病毒血症的 RR 更高（1.46 [95%CI：1.03-2.07]；P=0.03）。相比之下，患有 HIV 和 DM 的男性与未患有 DM 的男性相比，新发病毒血症的 RR 没有统计学差异（1.2 [95%CI：0.96-1.50]；P=0.12）。结果根据依从性水平（100%、95-99%和<95%基于自我报告）进行分层。
结论
与无 DM 的 HIV 阴性女性相比，ART 高度依从（100%自我报告的依从性）的 DM 女性新发病毒血症的风险较低。然而，DM 控制不佳的女性 HIV 病毒血症的风险高于 DM 控制良好的女性。需要进一步研究以了解性别、DM 和 ART 依从性对 HIV 病毒血症的影响。
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