德宏傣族景颇族自治州接受抗病毒治疗的HIV/AIDS糖尿病累积发病率的研究

目的  探究德宏傣族景颇族自治州(简称德宏州)接受抗病毒治疗(antiretroviral therapy, ART)的HIV感染者和AIDS病人(简称HIV/AIDS) 糖尿病3年累积发病率及其危险因素。方法  采用队列设计，于2017年7月―2018年6月招募接受ART的HIV/AIDS为研究对象，于2021年1月―2021年7月进行队列随访，采集静脉血检测糖化血红蛋白(hemoglobin A1c, HbA1c)。糖尿病判定标准为符合其中任意一项：HbA1c≥6.5%或最近1次FPG≥7.0 mmol/L。采用logistic回归分析模型分析糖尿病发病的影响因素。结果  本次分析纳入3 647例基线未患糖尿病的HIV/AIDS，平均年龄为42(36, 49)岁，男性占比51.4%，抗HCV IgG阳性率为21.5%，HIV感染确证平均时间为12.1(9.3, 14.6)年，ART平均时间为9.3(7.6, 12.2)年。糖尿病3年累积发病率为6.0%，其中HbA1c≥6.5%发病率为2.5%，FPG≥ 7.0 mmol/L发病率为5.3%。多因素logistic回归分析模型分析显示，年龄≥50岁、男性、HCV合并感染、基线TG升高、基线HIV病毒载量≥50 copies/mL和基线ART药物含依非韦伦(efavirenz, EFV)与糖尿病发病均呈正相关(均有P＜0.05)。结论  德宏州HIV/AIDS糖尿病累积发病率较高，应对该人群针对性采取综合防治措施，降低糖尿病累积发病风险。

Research on incident diabetes among HIV/AIDS receiving antiretroviral therapy in Dehong Dai and Jingpo Autonomous Prefecture

  Objective  To estimate the cumulative incidence and risk factors of diabetes among HIV/AIDS patients receiving antiretroviral therapy (ART) in Dehong Dai and Jingpo autonomous prefecture (Dehong), Yunnan Province.  Methods  HIV/AIDS patients without diabetes at baseline (Jul 2017 to Jun 2018) were followed from Jan. 2021 to June 2021. Data of participants were extracted from the National HIV/AIDS antiretroviral therapy database in China. All participants underwent hemoglobin A1c (HbA1c) testing. Diabetes was defined as follow-up HbA1c≥6.5% or the most recent FPG≥7.0 mmol/L. Logistic regression analysis was conducted to evaluate the risk factors of diabetes among HIV/AIDS patients.  Results  A total of 3 647 HIV/AIDS patients were included in this study, with 51.4% being male and median age of 42 (36, 49) years old. Anti-HCV antibodies were detected in 21.5% of participants. The median time since HIV diagnosis and duration on ART were 12.1 (9.3, 14.6) and 9.3 (7.6, 12.2) years, respectively. The 3-year cumulative incidence of diabetes, HbA1c≥6.5% and PFG≥ 7.0 mmol/L were 6.0%, 2.5% and 5.3%, respectively. Multivariate logistics regression analysis showed that baseline age of ≥50 years, male, HCV-coinfection, elevated TG at baseline, baseline HIV viral load of > 50 copies/ml, baseline use of efavirenz (EFV) were significantly associated with higher risk of incident diabetes. (All P < 0.05).  Conclusions  HIV/AIDS patients receiving ART in Dehong prefecture are at high risk of diabetes, underscoring needs of targeted prevention and intervention programs in this population.