整合酶链转移抑制剂相关的体重指数变化及糖尿病风险：来自RESPOND队列联盟的一项前瞻性研究

Integrase Strand Transfer Inhibitor-Related Changes in Body Mass Index and Risk of Diabetes: A Prospective Study From the RESPOND Cohort Consortium.

作者信息

Rupasinghe Dhanushi, Bansi-Matharu Loveleen, Law Matthew, Zangerle Robert, Rauch Andri, Tarr Philip E, Greenberg Lauren, Neesgaard Bastian, Jaschinski Nadine, De Wit Stéphane, Wit Ferdinand, d'Arminio Monforte Antonella, Fontas Eric, Castagna Antonella, Stecher Melanie, Florence Eric, Begovac Josip, Mussini Cristina, Sönnerborg Anders, Abutidze Akaki, Groh Ana, Vannappagari Vani, Cohen Cal, Young Lital, Hosein Sean, Ryom Lene, Petoumenos Kathy

机构信息

The Australian HIV Observational Database, The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia.

Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, United Kingdom.

出版信息

Clin Infect Dis. 2025 Feb 24;80(2):404-416. doi: 10.1093/cid/ciae406.

DOI:10.1093/cid/ciae406

PMID:39117341

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11848263/

Abstract

BACKGROUND

With integrase strand transfer inhibitor (INSTI) use associated with increased body mass index (BMI) and BMI increases associated with higher diabetes mellitus (DM) risk, we explored the relationships between INSTI/non-INSTI regimens, BMI changes, and DM risk.

METHODS

RESPOND participants were included if they had CD4, human immunodeficiency virus (HIV) RNA, and ≥2 BMI measurements during follow-up. Those with prior DM were excluded. DM was defined as a random blood glucose ≥11.1 mmol/L, hemoglobin A1c ≥6.5%/48 mmol/mol, use of antidiabetic medication, or site-reported clinical diagnosis. Poisson regression was used to assess the association between natural log (ln) of time-updated BMI and current INSTI/non-INSTI and their interactions on DM risk.

RESULTS

Among 20 865 people with HIV included, most were male (74%) and White (73%). Baseline median age was 45 years (interquartile range [IQR], 37-52), with a median BMI of 24 kg/m2 (IQR, 22-26). There were 785 DM diagnoses with a crude rate of 0.73 (95% confidence interval [CI], .68-.78)/100 person-years of follow-up. ln(BMI) was strongly associated with DM (adjusted incidence rate ratio [aIRR], 16.54 per log increase; 95% CI, 11.33-24.13; P < .001). Current INSTI use was associated with increased DM risk (IRR, 1.58; 95% CI, 1.37-1.82; P < .001) in univariate analyses and only partially attenuated when adjusted for variables including ln(BMI) (aIRR, 1.48; 95% CI, 1.29-1.71; P < .001). There were no interactions between ln(BMI), INSTI, and non-INSTI use and DM (P = .130).

CONCLUSIONS

In RESPOND, compared with non-INSTIs, current use of INSTIs was associated with an increased DM risk, which partially attenuated when adjusted for BMI changes and other variables.

摘要

背景

随着整合酶链转移抑制剂（INSTI）的使用与体重指数（BMI）增加相关，且BMI增加与更高的糖尿病（DM）风险相关，我们探讨了INSTI/非INSTI治疗方案、BMI变化和DM风险之间的关系。

方法

纳入RESPOND研究的参与者，要求他们在随访期间有CD4、人类免疫缺陷病毒（HIV）RNA以及≥2次BMI测量值。排除既往患有DM的患者。DM定义为随机血糖≥11.1 mmol/L、糖化血红蛋白≥6.5%/48 mmol/mol、使用抗糖尿病药物或研究点报告的临床诊断。采用泊松回归评估随时间更新的BMI的自然对数（ln）与当前INSTI/非INSTI及其对DM风险的相互作用之间的关联。

结果

在纳入的20865例HIV感染者中，大多数为男性（74%）和白人（73%）。基线中位年龄为45岁（四分位间距[IQR]，37 - 52岁），中位BMI为24 kg/m2（IQR，22 - 26）。有785例DM诊断，粗发病率为0.73（95%置信区间[CI]，0.68 - 0.78）/100人年随访。ln（BMI）与DM密切相关（调整后的发病率比[aIRR]，每增加一个对数单位为16.54；95% CI，11.33 - 24.13；P < 0.001）。在单因素分析中，当前使用INSTI与DM风险增加相关（发病率比[IRR]，1.58；95% CI，1.37 - 1.82；P < 0.001），而在调整包括ln（BMI）在内的变量后仅部分减弱（aIRR，1.48；95% CI，1.29 - 1.71；P < 0.001）。ln（BMI）、INSTI和非INSTI使用与DM之间无相互作用（P = 0.130）。