Age-specific abnormal glucose metabolism in HIV-positive people on antiviral therapy in China: a multicenter case-control study

Update, the link between HIV infection and abnormal glucose metabolism (AGM) is still unclear. This study aims to investigate the impact of HIV infection on AGM, including insulin resistance (IR), impaired fasting glucose (IFG), and diabetes mellitus (DM). A multicenter case-control study was conducted in Zhejiang province, China. After matching, the study included 1030 people living with HIV (PLWH) and 1030 people living without HIV (PLWTH). The age-specific incidence of AGM was compared between the two groups. Poisson regression models were used to calculate the relative risk (RR) and its 95% confidence interval (CI) to assess the associations. Compared to PLWTH, PLWH had a higher rate of IR, IFG and DM, and a higher risk of developing IR (RR: 1.83; 95% CI: 1.60–2.10), IFG (RR: 3.87; 95% CI: 2.55–6.07), and DM (RR: 1.52; 95% CI: 1.09–2.12). In the 30–44 age group, the risk of IR, IFG, and DM was the highest, with RRs of 2.04 (95%CI: 1.69–2.48), 7.46 (95%CI: 2.91–25.27), and 1.88 (95%CI: 0.90–4.10). HIV acquisition and cART usage >5 years were associated with increased risks of DM. HIV infection is associated with early onset and high prevalence of IR and IFG. Longer duration of HIV infection and cART usage increased the occurrence of DM. These findings contribute to a better understanding of age-specific AGM and the modified glucose monitor strategies in PLWH.

目前人类免疫缺陷病毒（HIV）感染与糖代谢异常（abnormal glucose metabolism, AGM）之间的关联机制尚未明确。本研究旨在探讨HIV感染对糖代谢异常的影响，涵盖胰岛素抵抗（insulin resistance, IR）、空腹血糖受损（impaired fasting glucose, IFG）及糖尿病（diabetes mellitus, DM）。本研究在中国浙江省开展一项多中心病例对照研究，经匹配后纳入1030例人类免疫缺陷病毒感染者（people living with HIV, PLWH）与1030例未感染HIV者（people living without HIV, PLWTH），比较两组人群的年龄别糖代谢异常发病率。采用泊松回归模型计算相对危险度（relative risk, RR）及其95%置信区间（confidence interval, CI），以评估二者的关联强度。与PLWTH相比，PLWH的IR、IFG及DM患病率更高，发生IR（RR=1.83；95%CI：1.60~2.10）、IFG（RR=3.87；95%CI：2.55~6.07）与DM（RR=1.52；95%CI：1.09~2.12）的风险均显著升高。在30~44岁年龄组中，PLWH发生IR、IFG及DM的风险最高，对应RR值分别为2.04（95%CI：1.69~2.48）、7.46（95%CI：2.91~25.27）及1.88（95%CI：0.90~4.10）。HIV感染时长与联合抗反转录病毒治疗（combined antiretroviral therapy, cART）时长超过5年均与DM风险升高相关。研究表明，HIV感染与IR及IFG的早发和高患病率显著相关；HIV感染时长及cART使用时长越长，DM的发生风险越高。上述研究结果有助于进一步明确不同年龄组AGM的发病特征，并为PLWH人群制定优化的血糖监测策略提供科学依据。