Short-term weight gain after antiretroviral therapy initiation and subsequent risk of cardiovascular disease and diabetes: the D:A:D study
Short-term weight gain after antiretroviral therapy initiation and subsequent risk of cardiovascular disease and diabetes: the D:A:D study
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DOI：
10.1111/hiv.12294
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发表时间：
2016-04-01
期刊：
影响因子：
3
通讯作者：
Law, M. G.
中科院分区：
文献类型：
--
作者：
Achhra, A. C.;Mocroft, A.;Law, M. G.
本研究的目的是评估抗逆转录病毒治疗(ART)后立即观察到的体重指数(BMI)增加对随后的心血管疾病(CVD)和糖尿病风险的影响。方法我们分析了抗HIV药物不良事件数据收集(D：A：D)队列研究的数据。结果是(I)心血管疾病(心肌梗死/中风/冠状动脉手术的综合)和(Ii)糖尿病。主要暴露变量是从ART开始(ART前)到开始治疗后1年(连续变量)的BMI变化，这些患者开始接受ART治疗，没有心血管疾病或糖尿病病史(对于各自的结果)。体重指数[体重(公斤)/(身高(米))(2)]被归类为体重不足(30)。泊松回归模型适用于每个抗逆转录病毒治疗前BMI类别的分层，以允许特定类别的发病率比(IRR)的估计。结果在43982人年(n=9321)和43278人年(n=9193)中总共发生了97次心血管事件和125次糖尿病事件。在对心血管疾病的完全调整分析中，根据ART前BMI类别，ART第一年BMI中的IRR/单位收益为：体重不足，0.90(0.60-1.37)；正常，1.18(1.05-1.33)；超重，0.87(0.70-1.10)，肥胖，0.95(0.71-1.28)(交互作用P=0.04)。对于糖尿病，BMI的IRR/单位增加为1.11(95%可信区间为1.03至1.21)，而不考虑ART治疗前的BMI(交互作用P>0.05)。结论ART治疗后BMI的短期增加似乎增加了心血管疾病的长期风险，但仅限于ART前BMI在正常范围内的患者。无论ART前BMI如何，它也与糖尿病风险增加有关。
ObjectivesThe aim of the study was to assess the impact of the gain in body mass index (BMI) observed immediately after antiretroviral therapy (ART) initiation on the subsequent risk of cardiovascular disease (CVD) and diabetes.MethodsWe analysed data from the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) cohort study. Outcomes were development of (i) CVD (composite of myocardial infarction/stroke/coronary procedure) and (ii) diabetes. The main exposure variable was change in BMI from ART initiation (pre-ART) to 1 year after initiation (continuous variable) in treatment-naive individuals initiating ART with no history of CVD or diabetes (for respective outcomes). BMI [weight (kg)/(height (m))(2)] was categorized as underweight (30). Poisson regression models were fitted stratified for each pre-ART BMI category to allow for category-specific estimates of incidence rate ratio (IRR). Models were adjusted for pre-ART BMI and CD4 count, key known risk factors (time-updated where possible) and calendar year.ResultsA total of 97 CVD events occurred in 43982 person-years (n=9321) and 125 diabetes events in 43278 person-years (n=9193). In fully adjusted analyses for CVD, the IRR/unit gain in BMI (95% confidence interval) in the first year of ART, by pre-ART BMI category, was: underweight, 0.90 (0.60-1.37); normal, 1.18 (1.05-1.33); overweight, 0.87 (0.70-1.10), and obese, 0.95 (0.71-1.28) (P for interaction=0.04). For diabetes, the IRR/unit gain in BMI was 1.11 (95% confidence interval 1.03 to 1.21), regardless of pre-ART BMI (P for interaction>0.05).ConclusionsShort-term gain in BMI following ART initiation appeared to increase the longer term risk of CVD, but only in those with pre-ART BMI in the normal range. It was also associated with increased risk of diabetes regardless of pre-ART BMI.