PDF(Pubmed)
Abstract：
Background: The increased risk of cardio-metabolic disorders associated with people living with human immunodeficiency virus (HIV) is of growing importance. Given the broad adoption of integrase strand-transfer inhibitor (INSTI)-based antiretroviral therapy (ART) as first-line therapy for HIV, additional data are needed regarding the metabolic effects of these regimens. Objective: The purpose of this study is to assess glycemic control in patients started on INSTI-based 3-drug regimens over a 2-year period. Methods: A retrospective study was conducted on patients seen in the Brooklyn Hospital Center. Men and nonpregnant, nonlactating women aged 18 years or older with a diagnosis of HIV who were initiated on or switched to an ART consisting of 2 nucleoside reverse transcriptase inhibitors (NRTIs) plus an INSTI were included in the analysis. The primary endpoint is change in A1C from baseline (pre-INSTI initiation) to 2 years after initiation. Results: Two hundred fifty-one patients were eligible based on specified inclusion and exclusion criteria. Overall, a statistically significant increase in A1C was seen in all patients started on INSTI-based regimen (95% CI, 0.10-0.36; P < 0.001). Primarily patients on both elvitegravir-based and bictegravir-based regimens saw the most significant increase in A1C: 0.16% (95% CI, 0.04-0.27; P = 0.006) and 0.39% (95% CI, 0.02-0.76; P = 0.038), respectively. Conclusion and Relevance: Integrase strand-transfer inhibitor-based 3-drug ART was associated with a small but statistically significant increase in A1C over a 2-year period, requiring additional monitoring by clinicians.
摘要：
背景：与人类免疫缺陷病毒（HIV）患者相关的心脏代谢紊乱风险增加越来越重要。鉴于以整合酶链转移抑制剂（INSTI）为基础的抗逆转录病毒疗法（ART）作为HIV的一线治疗被广泛采用，关于这些方案的代谢作用还需要更多的数据.目的：本研究的目的是评估开始使用基于INSTI的3种药物方案的患者在2年内的血糖控制。方法：对布鲁克林医院中心的患者进行回顾性研究。男人和未怀孕的人，本分析纳入了年龄在18岁或以上且被诊断为HIV的非哺乳期女性,这些女性开始接受或转为接受由2种核苷逆转录酶抑制剂(NRTIs)和INSTI组成的ART治疗.主要终点是A1C从基线（INSTI开始前）到开始后2年的变化。结果：根据指定的纳入和排除标准，有205名患者符合条件。总的来说,在所有开始采用INSTI治疗方案的患者中,A1C均出现统计学显著升高(95%CI,0.10~0.36;P<0.001).主要使用基于elvitegravir和基于bictegravir的方案的患者A1C的增加最明显：0.16％（95％CI，0.04-0.27；P=0.006）和0.39％（95％CI，0.02-0.76；P=0.038），分别。结论和相关性：基于整合酶链转移抑制剂的3-药物ART在2年内与A1C的小幅但统计学上显著的增加相关。需要临床医生的额外监测。
