Abstract

Background

Integrase strand transfer inhibitors (INSTIs) are increasingly used in patients living with HIV due to their safety, effectiveness and high genetic barrier. However, an association with weight gain has recently been suggested and several cases of diabetes mellitus have been reported with raltegravir and dolutegravir. The long-time metabolic impact of these recent molecules remains unclear.

Objectives

To assess if an INSTI as a third agent is statistically associated with new-onset diabetes mellitus compared with an NNRTI or a PI.

Patients and methods

Patients undergoing first-line combined ART (cART) without diabetes at baseline were retrospectively included from the Dat’AIDS French cohort study (ClinicalTrials.gov NCT02898987). Incident diabetes mellitus was defined as a notification of new diabetes in the medical history, a glycated haemoglobin (HbA1c) level superior to 7.5% or the start of a diabetes therapy following the initiation of ART.

Results

From 2009 to 2017, 19 462 patients were included, among which 265 cases of diabetes mellitus occurred. Multivariate and survival analyses did not highlight an increase in new-onset diabetes in patients undergoing cART with an INSTI as a third agent compared with an NNRTI or a PI. BMI >30 kg/m², age >37 years old (in survival analysis), black race or Hispanic ethnicity, arterial hypertension and AIDS were associated with a higher proportion of incident diabetes.

Conclusions

INSTIs were not statistically associated with new-onset diabetes. However, clinicians should remain aware of this possible metabolic comorbidity, particularly in patients with a high BMI and older patients.

中文翻译：

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一线整合酶链转移抑制剂治疗的HIV感染患者的糖尿病发病率：一项法国多中心回顾性研究。

摘要

背景

整合酶链转移抑制剂（INSTI）由于其安全性，有效性和高遗传屏障而越来越多地用于艾滋病毒感染者。但是，最近有人提出与体重增加有关，并且已经报道了一些使用拉格列韦和多卢格韦的糖尿病病例。这些新近分子的长期代谢影响尚不清楚。

目标

与NNRTI或PI相比，评估INSTI作为第三种药物是否与新发糖尿病具有统计学联系。

患者和方法

Dat'AIDS法国队列研究（ClinicalTrials.gov NCT02898987）回顾性纳入基线时未接受糖尿病的一线联合抗病毒治疗（cART）的患者。发生糖尿病的定义是在病史中出现新的糖尿病，糖化血红蛋白（HbA1c）水平高于7.5％或在开始ART后开始糖尿病治疗。

结果

从2009年至2017年，共纳入19462例患者，其中265例糖尿病发生。与NNRTI或PI相比，多变量和生存分析未显示接受INSTI作为第三种药物的cART患者的新发糖尿病的增加。BMI> 30 kg / m ²，年龄> 37岁（在生存分析中），黑人或西班牙裔种族，动脉高血压和AIDS与较高的糖尿病发病率相关。

结论

INSTIs与新发糖尿病无统计学相关性。但是，临床医生应始终注意这种可能的合并症，特别是在BMI较高的患者和年龄较大的患者中。