Incidence of Diabetes Mellitus and Obesity and the Overlap of Comorbidities in HIV+ Hispanics Initiating Antiretroviral Therapy.
Incidence of Diabetes Mellitus and Obesity and the Overlap of Comorbidities in HIV+ Hispanics Initiating Antiretroviral Therapy.
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DOI：
10.1371/journal.pone.0160797
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Taylor BS
中科院分区：
文献类型：
--
作者：
Gomes A;Reyes EV;Garduno LS;Rojas R;Mir Mesejo G;Del Rosario E;Jose L;Javier C;Vaughan C;Donastorg Y;Hammer S;Brudney K;Taylor BS
心血管疾病（CVD）是接受抗逆转录病毒治疗（ART）的HIV+患者的主要健康威胁;心脏代谢合并症是风险的关键预测因素。在低收入和中等收入国家（LMIC），特别是西班牙裔艾滋病毒阳性个体开始抗逆转录病毒治疗的代谢合并症发病率数据有限。我们研究了多米尼加共和国开始ART的前瞻性队列中糖尿病和肥胖的发病率。研究对象年龄≥18岁，在研究入组前90天内开始ART治疗，检查空腹血糖受损（IFG）、糖尿病（DM）、超重和肥胖的发生率。空腹血糖（FPG）100- 125 mg/dl定义为IFG; FPG ≥126 mg/dl、根据病历诊断或使用降糖药物定义为DM。超重和肥胖分别为BMI 25-30和≥ 30 kg/m2。血脂异常为总胆固醇≥ 240 mg/dl或使用降脂药物。在观察结束时，使用Fragrance风险方程确定10年CVD风险。在153例开始ART的患者中，基线时8例（6%）患有DM，23例（16%）患有IFG，6例发展为DM（28/1000人-年随访[PYFU]），46例发展为IFG（329/1000 PYFU）。基线时，24例（18%）肥胖，36例（27%）超重，15例肥胖（69/1000 PYFU），22例超重（163/1000 PYFU）。糖尿病和肥胖分析的中位观察期分别为23.5个月和24.3个月。13%的队列存在CVD风险增加（≥10% 10年Fragrance风险评分）; 79%的队列有≥1种心脏代谢合并症，48%有≥2种，13%有所有3种。在LMIC的西班牙裔队列中，IFG/DM和超重/肥胖的发病率与高收入国家相似或高于高收入国家，心脏代谢疾病影响了四分之三的开始ART的患者。需要将心血管风险降低纳入HIV治疗计划的护理模式，以预防该弱势人群中CVD相关的死亡率。
Cardiovascular disease (CVD) is a leading health threat for HIV+ patients on antiretroviral therapy (ART); cardiometabolic comorbidities are key predictors of risk. Data are limited on incidence of metabolic comorbidities in HIV+ individuals initiating ART in low and middle income countries (LMICs), particularly for Hispanics. We examined incidence of diabetes and obesity in a prospective cohort of those initiating ART in the Dominican Republic. Participants ≥18 years, initiating ART <90 days prior to study enrollment, were examined for incidence of impaired fasting glucose (IFG), diabetes mellitus (DM), overweight, and obesity. Fasting plasma glucose (FPG) 100-125mg/dl defined IFG; FPG ≥126 mg/dl, diagnosis per medical record, or use of hypoglycemic medication defined DM. Overweight and obesity were BMI 25–30 and ≥30kg/m2, respectively. Dyslipidemia was total cholesterol ≥240mg/dl or use of lipid-lowering medication. Framingham risk equation was used to determine ten-year CVD risk at the end of observation. Of 153 initiating ART, 8 (6%) had DM and 23 (16%) had IFG at baseline, 6 developed DM (28/1000 person-years follow up [PYFU]) and 46 developed IFG (329/1000 PYFU). At baseline, 24 (18%) were obese and 36 (27%) were overweight, 15 became obese (69/1000 PYFU) and 22 became overweight (163/1000 PYFU). Median observation periods for the diabetes and obesity analyses were 23.5 months and 24.3 months, respectively. Increased CVD risk (≥10% 10-year Framingham risk score) was present for 13% of the cohort; 79% of the cohort had ≥1 cardiometabolic comorbidity, 48% had ≥2, and 13% had all three. In this Hispanic cohort in an LMIC, incidences of IFG/DM and overweight/obesity were similar to or higher than that found in high income countries, and cardiometabolic disorders affected three-quarters of those initiating ART. Care models incorporating cardiovascular risk reduction into HIV treatment programs are needed to prevent CVD-associated mortality in this vulnerable population.