Nicola Squillace1, Patrizia Lorenzini2, Giuseppe Lapadula3, Alessandra Bandera3, Alessandro Cozzi-Lepri4, Stefano Rusconi5, Massimo Puoti6, Antonella Castagna7, Andrea Antinori2, Andrea Gori3, Antonella d'Arminio Monforte8. 1. Division of Infectious Diseases, Department of Internal Medicine, 'San Gerardo' Hospital, University Milano-Bicocca, Monza, Italy nicolasquillace74@gmail.com. 2. 'Lazzaro Spallanzani' National Institute for Infectious Diseases-IRCCS, Rome, Italy. 3. Division of Infectious Diseases, Department of Internal Medicine, 'San Gerardo' Hospital, University Milano-Bicocca, Monza, Italy. 4. Royal Free Centre for HIV Medicine & Department of Primary Care and Population Sciences, Royal Free and University College Medical School, Royal Free Campus, London, UK. 5. Infectious Diseases, Department of Biomedical and Clinical Science Luigi Sacco, University of Milan, Milan, Italy. 6. Infectious Disease Unit, Niguarda Cà Granda Hospital, Milan, Italy. 7. Department of Infectious Diseases, San Raffaele Scientific Institute, University Vita-Salute San Raffaele, Milan, Italy. 8. San Paolo University Hospital, Milan, Italy.
Abstract
OBJECTIVES: Our primary aim was to study diabetes mellitus (DM) arising during combination ART (cART) and to attempt to identify associations between these cases and triglycerides (TRG) and the TRG to HDL-cholesterol (TRG/HDL) ratio. Our secondary aim was to analyse the association between DM development and hepatic fibrosis. METHODS: This was a retrospective cohort study. Patients from the Icona Foundation study initiating first-line cART between 1997 and 2013 were selected and observed until new-onset DM or most recent clinical follow-up. The predictive value of TRG and TRG/HDL ratio levels on DM was evaluated using multivariable Poisson regression models. RESULTS: Three-thousand, five-hundred and forty-six patients (males, 73.7%; median age, 38 years; median BMI, 23.1 kg/m(2); and hepatitis C virus antibody positive, 22.1%) were included. Of these, 80 developed DM over 13 911 person-years of follow-up (PYFU), corresponding to 5.7 cases per 1000 PYFU (95% CI = 4.6-7.1). At multivariable analysis, latest TRG/HDL ratio, when high, was associated with significant increases in DM risk [relative risk (RR) = 1.63; 95% CI = 1.32-2.01 per 10 points higher], while current TRG, in contrast, was associated with new-onset DM only at crude analysis. Advanced liver fibrosis (defined as fibrosis-4 index >3.25) was also shown to be an independent risk factor for DM (RR = 2.91; 95% CI = 1.10-7.72). CONCLUSIONS: High TRG/HDL ratio predicted risk of new-onset DM, independently of other traditional risk factors. Furthermore, our findings suggest that advanced hepatic fibrosis, estimated using the fibrosis-4 score, could provide an additional predictor for DM.
OBJECTIVES: Our primary aim was to study diabetes mellitus (DM) arising during combination ART (cART) and to attempt to identify associations between these cases and triglycerides (TRG) and the TRG to HDL-cholesterol (TRG/HDL) ratio. Our secondary aim was to analyse the association between DM development and hepatic fibrosis. METHODS: This was a retrospective cohort study. Patients from the Icona Foundation study initiating first-line cART between 1997 and 2013 were selected and observed until new-onset DM or most recent clinical follow-up. The predictive value of TRG and TRG/HDL ratio levels on DM was evaluated using multivariable Poisson regression models. RESULTS: Three-thousand, five-hundred and forty-six patients (males, 73.7%; median age, 38 years; median BMI, 23.1 kg/m(2); and hepatitis C virus antibody positive, 22.1%) were included. Of these, 80 developed DM over 13 911 person-years of follow-up (PYFU), corresponding to 5.7 cases per 1000 PYFU (95% CI = 4.6-7.1). At multivariable analysis, latest TRG/HDL ratio, when high, was associated with significant increases in DM risk [relative risk (RR) = 1.63; 95% CI = 1.32-2.01 per 10 points higher], while current TRG, in contrast, was associated with new-onset DM only at crude analysis. Advanced liver fibrosis (defined as fibrosis-4 index >3.25) was also shown to be an independent risk factor for DM (RR = 2.91; 95% CI = 1.10-7.72). CONCLUSIONS: High TRG/HDL ratio predicted risk of new-onset DM, independently of other traditional risk factors. Furthermore, our findings suggest that advanced hepatic fibrosis, estimated using the fibrosis-4 score, could provide an additional predictor for DM.
Authors: A Hanttu; K J Kauppinen; P Kivelä; J Ollgren; P Jousilahti; K Liitsola; P Koponen; J Sutinen Journal: HIV Med Date: 2020-11-09 Impact factor: 3.180
Authors: Alex J F Cassenote; Alexandre Grangeiro; Maria M Escuder; Jair M Abe; Raul D Santos; Aluisio C Segurado Journal: Braz J Infect Dis Date: 2021-08-31 Impact factor: 3.257