The impact of diabetes mellitus on HIV virologic control: results of the MACS/WIHS combined cohort study.

IF 3.4 2区医学 Q3 IMMUNOLOGY AIDS Pub Date : 2024-11-15 Epub Date: 2024-07-18 DOI:10.1097/QAD.0000000000003978

Sarah C Mann, Weiqun Tong, Alison G Abraham, Frank Palella, Anjali Sharma, Phyllis C Tien, Margaret A Fischl, Samy I McFarlane, Cecile D Lahiri, Susan Koletar, Daniel Merenstein, Michelle Floris-Moore, Jordan E Lake, Elizabeth Daubert, Aubri Hickman, Todd T Brown, Jose Castillo-Mancilla

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Abstract

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.

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糖尿病对艾滋病病毒控制的影响：MACS/WIHS 联合队列研究的结果。

目的：在艾滋病病毒感染者（PWH）中，糖尿病（DM）与较低的抗逆转录病毒（ART）药物暴露相关，而非糖尿病（DM）患者则与较低的抗逆转录病毒（ART）药物暴露相关。然而，PWH 中糖尿病与病毒学控制之间的关系仍然未知：我们纳入了多中心艾滋病队列研究/妇女机构间艾滋病研究联合队列研究（MWCCS）的参与者，他们在 1999 年至 2020 年间开始接受抗逆转录病毒疗法，并在开始接受抗逆转录病毒疗法后 1 年内抑制了 HIV 病毒载量（≤200 copies/mL）。我们比较了患有和不患有糖尿病的成年 PWH 发生 HIV 病毒血症（HIV-1 RNA >200 copies/mL）的频率。我们使用泊松回归法来研究基于 DM 诊断的 PWH 感染病毒的发生率。DM的定义是连续两次空腹血糖测量值≥126 mg/dL、使用抗糖尿病药物、原有DM诊断或确诊HbA1c>6.5%：分析对象包括 1,061 名女性（112 人患有糖尿病，949 人未患有糖尿病）和 633 名男性（41 人患有糖尿病，592 人未患有糖尿病）。与未患有 DM 的女性相比，患有 HIV 和 DM 的女性感染 HIV 病毒的相对比率（RR）较低（0.85 [95% CI：0.72-0.99]；P = 0.04）。与 DM 得到控制的女性（HbA1c 结论：HbA1c＞7.5%）相比，DM 未得到控制的女性（HbA1c＞7.5%）的病毒血症发生率更高（0.85 [95 CI：0.72-0.99]；P = 0.04）：与未患糖尿病的女性艾滋病患者相比，高度坚持抗逆转录病毒疗法（自我报告坚持率为 100%）的女性糖尿病患者发生病毒血症的风险较低。然而，与糖尿病得到控制的女性相比，糖尿病控制不佳的女性感染艾滋病病毒的风险更高。要了解性别、糖尿病和坚持抗逆转录病毒疗法对艾滋病病毒血症的影响，还需要进一步的研究。

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来源期刊

AIDS 医学-病毒学

CiteScore

5.90

自引率

5.30%

发文量

478

审稿时长

3 months

期刊介绍： Publishing the very latest ground breaking research on HIV and AIDS. Read by all the top clinicians and researchers, AIDS has the highest impact of all AIDS-related journals. With 18 issues per year, AIDS guarantees the authoritative presentation of significant advances. The Editors, themselves noted international experts who know the demands of your work, are committed to making AIDS the most distinguished and innovative journal in the field. Submitted articles undergo a preliminary review by the editor. Some articles may be returned to authors without further consideration. Those being considered for publication will undergo further assessment and peer-review by the editors and those invited to do so from a reviewer pool.