Ten-year diabetes incidence in 1046 HIV-infected patients started on a combination antiretroviral treatment
Ten-year diabetes incidence in 1046 HIV-infected patients started on a combination antiretroviral treatment
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DOI：
10.1097/qad.0b013e32834e8776
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发表时间：
2012-01-28
期刊：
影响因子：
3.8
通讯作者：
Chene, Genevieve
中科院分区：
文献类型：
--
作者：
Capeau, Jacqueline;Bouteloup, Vincent;Chene, Genevieve
目的：评估 19971999 年开始接受联合抗逆转录病毒治疗 (cART) 并随访至 2009 年的 HIV 感染成人队列中糖尿病的发病率和决定因素。设计：对 47 个法国临床中心的 1046 名患者进行前瞻性研究。方法：通过比例风险模型评估糖尿病发生的潜在决定因素，即确认的血糖升高和/或开始抗糖尿病治疗，包括时间更新的代谢参数和 ART 暴露。结果：在代表 7846 人年随访 (PYFU) 的队列中，54% 接受茚地那韦治疗，75% 接受司他夫定治疗，52% 接受去羟肌苷治疗。总体而言，111 名患者患有糖尿病，发病率为 14.1/1000 PYFU（男性 14.6，女性 12.6）。发病率在 1999-2000 年达到顶峰（23.2/1000 PYFU），此后有所下降。糖尿病的发病率与年龄（40-49 岁时风险比 = 2.13，≥ 50 岁时风险比 = 3.63）、超重（BMI 25-29 kg/m(2) 时风险比 = 1.91，风险比 = 2.85 2.85 > 30）相关[调整后风险比 (aHR)，所有 P < 0.02] kg/m(2))、腰臀比（≥ 0.97 名男性/0.92 名女性的风险比 = 3.87）、随时间更新的脂肪萎缩（风险比 = 2.14）和短期暴露于茚地那韦（0-1 年：风险比 = 2.53）、司他夫定（0-1 年：风险比 = 2.56，1-2 年：风险比 = 2.65）或去羟肌苷（2-3 年：风险比 = 3.16）。糖尿病的发生与艾滋病毒相关标志物、丙型肝炎、高血压或糖尿病家族史无关。胰岛素抵抗是糖尿病发病的预测因素。 结论：在这项全国性队列中，在 cART 开始后跟踪了 10 年，糖尿病发病率在 1990-2000 年达到顶峰，明显高于欧洲未感染或其他 HIV 感染人群 (4-6/1000 PYFU) 的报道，并且与年龄和肥胖有关。应监测老年艾滋病毒感染者的肥胖和血糖标志物。 (C) 2012 年威科健康 |利平科特·威廉姆斯·威尔金斯
Objective: To evaluate the incidence and determinants of diabetes in a cohort of HIV-infected adults initiated with combination antiretroviral treatment (cART) in 19971999 and followed up to 2009.Design: Prospective study of 1046 patients at 47 French clinical sites.Methods: Potential determinants of diabetes occurrence, defined by confirmed increased glycemia and/or initiation of antidiabetic treatment, were assessed by a proportional hazards model, including time-updated metabolic parameters and ART exposure.Results: Among the cohort, representing 7846 person-years of follow-up (PYFU), 54% received indinavir, 75% stavudine and 52% didanosine. Overall, 111 patients developed diabetes, with an incidence of 14.1/1000 PYFU (14.6 in men, 12.6 in women). Incidence peaked in 1999-2000 (23.2/1000 PYFU) and decreased thereafter. The incidence of diabetes was associated [adjusted hazard ratio (aHR), all P < 0.02] with older age (hazard ratio = 2.13 when 40-49 years, hazard ratio = 3.63 when >= 50 years), overweight (hazard ratio = 1.91 for a BMI 25-29 kg/m(2), hazard ratio = 2.85 2.85 > 30 kg/m(2)), waist-to-hip ratio (hazard ratio = 3.87 for >= 0.97 male/0.92 female), time-updated lipoatrophy (hazard ratio = 2.14) and short-term exposure to indinavir (0-1year: hazard ratio = 2.53), stavudine (0-1year: hazard ratio = 2.56, 1-2years: hazard ratio = 2.65) or didanosine (2-3years: hazard ratio = 3.16). Occurrence of diabetes was not associated with HIV-related markers, hepatitis C, hypertension or family history of diabetes. Insulin resistance was predictive for incident diabetes.Conclusions: In this nationwide cohort, followed for 10 years after cART initiation, diabetes incidence peaked in 1990-2000, was markedly higher than that reported for European uninfected or other HIV-infected populations (4-6/1000 PYFU) and linked with age and adiposity. Adiposity and glycemic markers should be monitored in aging HIV-infected patients. (C) 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins