Display options
Cite
Paengsai N, Jourdain G, Salvadori N, et al. Recommended First-Line Antiretroviral Therapy Regimens and Risk of Diabetes Mellitus in HIV-Infected Adults in Resource-Limited Settings. Open Forum Infect Dis. 2019;6(10):ofz298doi: 10.1093/ofid/ofz298.
Paengsai, N., Jourdain, G., Salvadori, N., Tantraworasin, A., Mary, J. Y., Cressey, T. R., Chaiwarith, R., Bowonwatanuwong, C., Bhakeecheep, S., & Kosachunhanun, N. (2019). Recommended First-Line Antiretroviral Therapy Regimens and Risk of Diabetes Mellitus in HIV-Infected Adults in Resource-Limited Settings. Open forum infectious diseases, 6(10), ofz298. https://doi.org/10.1093/ofid/ofz298
Paengsai, Ninutcha, et al. "Recommended First-Line Antiretroviral Therapy Regimens and Risk of Diabetes Mellitus in HIV-Infected Adults in Resource-Limited Settings." Open forum infectious diseases vol. 6,10 (2019): ofz298. doi: https://doi.org/10.1093/ofid/ofz298
Paengsai N, Jourdain G, Salvadori N, Tantraworasin A, Mary JY, Cressey TR, Chaiwarith R, Bowonwatanuwong C, Bhakeecheep S, Kosachunhanun N. Recommended First-Line Antiretroviral Therapy Regimens and Risk of Diabetes Mellitus in HIV-Infected Adults in Resource-Limited Settings. Open Forum Infect Dis. 2019 Sep 30;6(10):ofz298. doi: 10.1093/ofid/ofz298. eCollection 2019 Oct. PMID: 31660327; PMCID: PMC6778321.
Copy Download .nbib Format: NLM
Share it on

Open Forum Infect Dis. 2019 Sep 30;6(10):ofz298. doi: 10.1093/ofid/ofz298. eCollection 2019 Oct.

Recommended First-Line Antiretroviral Therapy Regimens and Risk of Diabetes Mellitus in HIV-Infected Adults in Resource-Limited Settings.

Open forum infectious diseases

Ninutcha Paengsai, Gonzague Jourdain, Nicolas Salvadori, Apichat Tantraworasin, Jean Yves Mary, Tim Roy Cressey, Romanee Chaiwarith, Chureeratana Bowonwatanuwong, Sorakij Bhakeecheep, Natapong Kosachunhanun

Affiliations

  1. Clinical Epidemiology Program, Faculty of Medicine, Chiang Mai University, Thailand.
  2. National Health Security Office, Bangkok, Thailand.
  3. Institut de Recherche pour le Developpement (IRD), France.
  4. Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Thailand.
  5. Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
  6. Department of Surgery, Faculty of Medicine, Chiang Mai University, Thailand.
  7. INSERM UMR 1135, Equipe ECSTRA, Centre de Recherche Epidémiologie et Biostatistique Sorbonne Paris Cité, Université Paris Diderot, France.
  8. Department of Molecular and Clinical Pharmacology, University of Liverpool, United Kingdom.
  9. Department of Medicine, Faculty of Medicine, Chiang Mai University, Thailand.
  10. Department of Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
  11. School of Medicine, University of Phayao, Thailand.

PMID: 31660327 PMCID: PMC6778321 DOI: 10.1093/ofid/ofz298

Abstract

OBJECTIVE: The use of some antiretroviral drugs has been associated with a higher risk of diabetes mellitus (DM) in HIV-infected patients, but the risk associated with antiretroviral drug combinations remains unclear. We investigated the association between first-line antiretroviral therapy (ART) regimens, recommended by the World Health Organization (WHO) in 2016, and the risk of DM in adults.

METHOD: We selected all HIV-infected adults within the Thai National AIDS Program who started a first-line ART regimen consisting the following between October 2006 and September 2013: zidovudine+lamivudine+nevirapine; tenofovir disoproxil fumarate (TDF)+lamivudine+nevirapine; zidovudine+lamivudine+efavirenz; TDF+lamivudine/emtricitabine+efavirenz; zidovudine+lamivudine+ritonavir-boosted lopinavir (LPV/r); or TDF+lamivudine+LPV/r. Diagnosis of DM was defined as having at least 2 of the following characteristics: fasting plasma glucose ≥126 mg/dl, 2010 WHO ICD-10 codes E11-E14, or prescription of antidiabetic drugs. To identify ART regimens associated with DM, we used competing risks regression models that considered mortality without DM as a competing event and adjusted for sex, age, pancreas disease, and stratified by groups defined by a score summarizing the propensity to receive a specific first-line ART regimen.

RESULTS: Data from 35 710 adults (49.1% male; median age, 35.0 years; median follow-up, 2.0 years) were included. In the multivariable analysis with zidovudine+lamivudine+nevirapine as the reference group, a higher risk of DM was observed with TDF+lamivudine/emtricitabine+efavirenz (adjusted sub-distribution hazard ratio [aSHR], 1.6; 95% confidence interval [CI], 1.3-1.9), zidovudine+lamivudine+efavirenz (aSHR, 2.0; 95% CI, 1.7-2.3), and TDF+lamivudine+LPV/r (aSHR, 2.7; 95% CI, 1.9-3.9).

CONCLUSIONS: Several of the WHO recommended ART regimens, particularly tenofovir + lamivudine +LPV/r and regimens containing efavirenz, may be associated with an increased risk of DM.

© The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America.

Keywords: HIV; antiretroviral treatment regimen; diabetes mellitus; efavirenz; ritonavir-boosted lopinavir

References

  1. Circulation. 2009 Feb 17;119(6):805-11 - PubMed
  2. Diabetes Care. 2013 Jan;36 Suppl 1:S11-66 - PubMed
  3. Indian J Gastroenterol. 2017 Mar;36(2):131-136 - PubMed
  4. Clin Infect Dis. 2007 Jul 1;45(1):111-9 - PubMed
  5. J Acquir Immune Defic Syndr. 2015 Aug 1;69(4):453-9 - PubMed
  6. AIDS. 2007 Aug 20;21(13):1739-45 - PubMed
  7. BMC Med Res Methodol. 2010 Oct 21;10:97 - PubMed
  8. Diabetes Care. 2008 Jun;31(6):1224-9 - PubMed
  9. J Med Assoc Thai. 2005 Dec;88(12):1896-904 - PubMed
  10. Biomed Res Int. 2017;2017:7481597 - PubMed
  11. Int J Methods Psychiatr Res. 2011 Mar;20(1):40-9 - PubMed
  12. Medicine (Baltimore). 2016 Mar;95(9):e2844 - PubMed
  13. Diabetes Res Clin Pract. 2008 Feb;79(2):343-9 - PubMed
  14. Arch Intern Med. 2005 May 23;165(10):1179-84 - PubMed
  15. Endocr Pract. 2012 Mar-Apr;18 Suppl 1:1-78 - PubMed
  16. Dtsch Arztebl Int. 2016 Sep 5;113(35-36):597-603 - PubMed
  17. AIDS. 2017 Jul 17;31(11):1535-1543 - PubMed
  18. Epidemiology. 2018 May;29(3):431-441 - PubMed
  19. Crit Care. 2008;12(2):134 - PubMed
  20. Diabet Med. 2014 Oct;31(10):1185-93 - PubMed
  21. Asia Pac J Clin Nutr. 2008;17(3):370-4 - PubMed
  22. HIV Med. 2009 May;10(5):302-9 - PubMed
  23. BMC Infect Dis. 2017 Jan 7;17(1):43 - PubMed
  24. AIDS. 2012 Jan 28;26(3):303-14 - PubMed
  25. BMC Public Health. 2018 Aug 30;18(1):1079 - PubMed

Publication Types