Incidence and Risk Factors for New-Onset Diabetes in HIV-lnfected Patients : The Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) Study
Identifieur interne : 008C61 ( Main/Exploration ); précédent : 008C60; suivant : 008C62Incidence and Risk Factors for New-Onset Diabetes in HIV-lnfected Patients : The Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) Study
Auteurs : Stephane De Wit [Belgique] ; Caroline A. Sabin [Royaume-Uni] ; Rainer Weber [Suisse] ; Signe Westring Worm [Danemark] ; Peter Reiss [Pays-Bas] ; Charles Cazanave [France] ; Wafaa El-Sadr [États-Unis] ; Antonella D'Arminio Monforte [Italie] ; Eric Fontas [France] ; Matthew G. Law [Australie] ; Nina Friis-Moller [Danemark] ; Andrew Phillips [Royaume-Uni]Source :
- Diabetes care [ 0149-5992 ] ; 2008.
Descripteurs français
- Pascal (Inist)
- Wicri :
- topic : Diabète, Médicament, Nutrition, Homme.
English descriptors
- KwdEn :
Abstract
OBJECTIVE - The aims of this study were to determine the incidence of diabetes among HIV-infected patients in the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) cohort, to identify demographic, HIV-related, and combination antiretroviral therapy (cART)-related factors associated with the onset of diabetes, and to identify possible mechanisms for any relationships found. RESEARCH DESIGN AND METHODS - D:A:D is a prospective observational study of 33,389 HIV-infected patients; diabetes is a study end point. Poisson regression models were used to assess the relation between diabetes and exposure to cART after adjusting for known risk factors for diabetes, CD4 count, lipids, and lipodystrophy. RESULTS Over 130,151 person-years of follow-up (PYFU), diabetes was diagnosed in 744 patients (incidence rate of 5.72 per 1,000 PYFU [95% Cl 5.31-6.13[). The incidence of diabetes increased with cumulative exposure to cART, an association that remained significant after adjustment for potential risk factors for diabetes. The strongest relationship with diabetes was exposure to stavudine; exposures to zidovudine and didanosine were also associated with an increased risk of diabetes. Time-updated measurements of total cholesterol, HDL cholesterol, and triglycerides were all associated with diabetes. Adjusting for each of these variables separately reduced the relationship between cART and diabetes slightly. Although lipodystrophy was significantly associated with diabetes, adjustment for this did not modify the relationship between cART and diabetes. CONCLUSION - Stavudine and zidovudine are significantly associated with diabetes after adjustment for risk factors for diabetes and lipids. Adjustment for lipodystrophy did not modify the relationship, suggesting that the two thymidine analogs probably directly contribute to insulin resistance, potentially through mitochondrial toxicity.
Url:
Affiliations:
- Australie, Belgique, Danemark, France, Italie, Pays-Bas, Royaume-Uni, Suisse, États-Unis
- Angleterre, Aquitaine, Grand Londres, Hollande-Septentrionale, Hovedstaden, Lombardie, Nouvelle-Aquitaine, Nouvelle-Galles du Sud, Provence-Alpes-Côte d'Azur, Région de Bruxelles-Capitale, État de New York
- Amsterdam, Bordeaux, Bruxelles, Copenhague, Londres, Milan, New York, Nice, Sydney
- Université Columbia
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Le document en format XML
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Sabin</name><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>Royal Free and University College</s1><s2>London</s2><s3>GBR</s3><sZ>2 aut.</sZ><sZ>12 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Weber, Rainer" sort="Weber, Rainer" uniqKey="Weber R" first="Rainer" last="Weber">Rainer Weber</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>University Hospital Zurich</s1><s2>Zurich</s2><s3>CHE</s3><sZ>3 aut.</sZ></inist:fA14><country>Suisse</country><wicri:noRegion>University Hospital Zurich</wicri:noRegion></affiliation></author><author><name sortKey="Westring Worm, Signe" sort="Westring Worm, Signe" uniqKey="Westring Worm S" first="Signe" last="Westring Worm">Signe Westring Worm</name><affiliation wicri:level="3"><inist:fA14 i1="04"><s1>University of Copenhagen</s1><s2>Copenhagen</s2><s3>DNK</s3><sZ>4 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>Danemark</country><placeName><settlement type="city">Copenhague</settlement><region type="région" nuts="2">Hovedstaden</region></placeName></affiliation></author><author><name sortKey="Reiss, Peter" sort="Reiss, Peter" uniqKey="Reiss P" first="Peter" last="Reiss">Peter Reiss</name><affiliation wicri:level="3"><inist:fA14 i1="05"><s1>Academic Medical Center</s1><s2>Amsterdam</s2><s3>NLD</s3><sZ>5 aut.</sZ></inist:fA14><country>Pays-Bas</country><placeName><settlement type="city">Amsterdam</settlement><region nuts="2" type="province">Hollande-Septentrionale</region></placeName></affiliation></author><author><name sortKey="Cazanave, Charles" sort="Cazanave, Charles" uniqKey="Cazanave C" first="Charles" last="Cazanave">Charles Cazanave</name><affiliation wicri:level="3"><inist:fA14 i1="06"><s1>Bordeaux 2 University</s1><s2>Bordeaux</s2><s3>FRA</s3><sZ>6 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Nouvelle-Aquitaine</region><region type="old region">Aquitaine</region><settlement type="city">Bordeaux</settlement></placeName></affiliation></author><author><name sortKey="El Sadr, Wafaa" sort="El Sadr, Wafaa" uniqKey="El Sadr W" first="Wafaa" last="El-Sadr">Wafaa El-Sadr</name><affiliation wicri:level="4"><inist:fA14 i1="07"><s1>Columbia University, Harlem Hospital</s1><s2>New York, New York</s2><s3>USA</s3><sZ>7 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">État de New York</region><settlement type="city">New York</settlement></placeName><orgName type="university">Université Columbia</orgName></affiliation></author><author><name sortKey="D Arminio Monforte, Antonella" sort="D Arminio Monforte, Antonella" uniqKey="D Arminio Monforte A" first="Antonella" last="D'Arminio Monforte">Antonella D'Arminio Monforte</name><affiliation wicri:level="3"><inist:fA14 i1="08"><s1>University of Milan</s1><s2>Milan</s2><s3>ITA</s3><sZ>8 aut.</sZ></inist:fA14><country>Italie</country><placeName><settlement type="city">Milan</settlement><region nuts="2">Lombardie</region></placeName></affiliation></author><author><name sortKey="Fontas, Eric" sort="Fontas, Eric" uniqKey="Fontas E" first="Eric" last="Fontas">Eric Fontas</name><affiliation wicri:level="3"><inist:fA14 i1="09"><s1>Centre Hospitalier Universitaire Nice, Hôpital de l'Archet</s1><s2>Nice</s2><s3>FRA</s3><sZ>9 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Provence-Alpes-Côte d'Azur</region><region type="old region">Provence-Alpes-Côte d'Azur</region><settlement type="city">Nice</settlement></placeName></affiliation></author><author><name sortKey="Law, Matthew G" sort="Law, Matthew G" uniqKey="Law M" first="Matthew G." last="Law">Matthew G. Law</name><affiliation wicri:level="3"><inist:fA14 i1="10"><s1>National Centre in HIV Epidemiology and Clinical Research</s1><s2>Sydney</s2><s3>AUS</s3><sZ>10 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region></placeName></affiliation></author><author><name sortKey="Friis Moller, Nina" sort="Friis Moller, Nina" uniqKey="Friis Moller N" first="Nina" last="Friis-Moller">Nina Friis-Moller</name><affiliation wicri:level="3"><inist:fA14 i1="04"><s1>University of Copenhagen</s1><s2>Copenhagen</s2><s3>DNK</s3><sZ>4 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>Danemark</country><placeName><settlement type="city">Copenhague</settlement><region type="région" nuts="2">Hovedstaden</region></placeName></affiliation></author><author><name sortKey="Phillips, Andrew" sort="Phillips, Andrew" uniqKey="Phillips A" first="Andrew" last="Phillips">Andrew Phillips</name><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>Royal Free and University College</s1><s2>London</s2><s3>GBR</s3><sZ>2 aut.</sZ><sZ>12 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author></analytic><series><title level="j" type="main">Diabetes care</title><title level="j" type="abbreviated">Diabetes care</title><idno type="ISSN">0149-5992</idno><imprint><date when="2008">2008</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Diabetes care</title><title level="j" type="abbreviated">Diabetes care</title><idno type="ISSN">0149-5992</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>AIDS</term><term>Antiviral</term><term>Cohort study</term><term>Complication</term><term>Data gathering</term><term>Diabetes mellitus</term><term>Drug</term><term>Drug combination</term><term>Early stage</term><term>Endocrinology</term><term>Epidemiology</term><term>Human</term><term>Incidence</term><term>Metabolic diseases</term><term>Nutrition</term><term>Risk factor</term><term>Secondary effect</term><term>Statistical analysis</term><term>Toxicity</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Diabète</term><term>Incidence</term><term>Epidémiologie</term><term>SIDA</term><term>Facteur risque</term><term>Stade précoce</term><term>Collecte donnée</term><term>Toxicité</term><term>Complication</term><term>Effet secondaire</term><term>Antiviral</term><term>Médicament</term><term>Association médicamenteuse</term><term>Etude cohorte</term><term>Analyse statistique</term><term>Endocrinologie</term><term>Maladie métabolique</term><term>Nutrition</term><term>Homme</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Diabète</term><term>Médicament</term><term>Nutrition</term><term>Homme</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">OBJECTIVE - The aims of this study were to determine the incidence of diabetes among HIV-infected patients in the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) cohort, to identify demographic, HIV-related, and combination antiretroviral therapy (cART)-related factors associated with the onset of diabetes, and to identify possible mechanisms for any relationships found. RESEARCH DESIGN AND METHODS - D:A:D is a prospective observational study of 33,389 HIV-infected patients; diabetes is a study end point. Poisson regression models were used to assess the relation between diabetes and exposure to cART after adjusting for known risk factors for diabetes, CD4 count, lipids, and lipodystrophy. RESULTS Over 130,151 person-years of follow-up (PYFU), diabetes was diagnosed in 744 patients (incidence rate of 5.72 per 1,000 PYFU [95% Cl 5.31-6.13[). The incidence of diabetes increased with cumulative exposure to cART, an association that remained significant after adjustment for potential risk factors for diabetes. The strongest relationship with diabetes was exposure to stavudine; exposures to zidovudine and didanosine were also associated with an increased risk of diabetes. Time-updated measurements of total cholesterol, HDL cholesterol, and triglycerides were all associated with diabetes. Adjusting for each of these variables separately reduced the relationship between cART and diabetes slightly. Although lipodystrophy was significantly associated with diabetes, adjustment for this did not modify the relationship between cART and diabetes. CONCLUSION - Stavudine and zidovudine are significantly associated with diabetes after adjustment for risk factors for diabetes and lipids. Adjustment for lipodystrophy did not modify the relationship, suggesting that the two thymidine analogs probably directly contribute to insulin resistance, potentially through mitochondrial toxicity.</div></front></TEI><affiliations><list><country><li>Australie</li><li>Belgique</li><li>Danemark</li><li>France</li><li>Italie</li><li>Pays-Bas</li><li>Royaume-Uni</li><li>Suisse</li><li>États-Unis</li></country><region><li>Angleterre</li><li>Aquitaine</li><li>Grand Londres</li><li>Hollande-Septentrionale</li><li>Hovedstaden</li><li>Lombardie</li><li>Nouvelle-Aquitaine</li><li>Nouvelle-Galles du Sud</li><li>Provence-Alpes-Côte d'Azur</li><li>Région de Bruxelles-Capitale</li><li>État de New York</li></region><settlement><li>Amsterdam</li><li>Bordeaux</li><li>Bruxelles</li><li>Copenhague</li><li>Londres</li><li>Milan</li><li>New York</li><li>Nice</li><li>Sydney</li></settlement><orgName><li>Université Columbia</li></orgName></list><tree><country name="Belgique"><region name="Région de Bruxelles-Capitale"><name sortKey="De Wit, Stephane" sort="De Wit, Stephane" uniqKey="De Wit S" first="Stephane" last="De Wit">Stephane De Wit</name></region></country><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Sabin, Caroline A" sort="Sabin, Caroline A" uniqKey="Sabin C" first="Caroline A." last="Sabin">Caroline A. Sabin</name></region><name sortKey="Phillips, Andrew" sort="Phillips, Andrew" uniqKey="Phillips A" first="Andrew" last="Phillips">Andrew Phillips</name></country><country name="Suisse"><noRegion><name sortKey="Weber, Rainer" sort="Weber, Rainer" uniqKey="Weber R" first="Rainer" last="Weber">Rainer Weber</name></noRegion></country><country name="Danemark"><region name="Hovedstaden"><name sortKey="Westring Worm, Signe" sort="Westring Worm, Signe" uniqKey="Westring Worm S" first="Signe" last="Westring Worm">Signe Westring Worm</name></region><name sortKey="Friis Moller, Nina" sort="Friis Moller, Nina" uniqKey="Friis Moller N" first="Nina" last="Friis-Moller">Nina Friis-Moller</name></country><country name="Pays-Bas"><region name="Hollande-Septentrionale"><name sortKey="Reiss, Peter" sort="Reiss, Peter" uniqKey="Reiss P" first="Peter" last="Reiss">Peter Reiss</name></region></country><country name="France"><region name="Nouvelle-Aquitaine"><name sortKey="Cazanave, Charles" sort="Cazanave, Charles" uniqKey="Cazanave C" first="Charles" last="Cazanave">Charles Cazanave</name></region><name sortKey="Fontas, Eric" sort="Fontas, Eric" uniqKey="Fontas E" first="Eric" last="Fontas">Eric Fontas</name></country><country name="États-Unis"><region name="État de New York"><name sortKey="El Sadr, Wafaa" sort="El Sadr, Wafaa" uniqKey="El Sadr W" first="Wafaa" last="El-Sadr">Wafaa El-Sadr</name></region></country><country name="Italie"><region name="Lombardie"><name sortKey="D Arminio Monforte, Antonella" sort="D Arminio Monforte, Antonella" uniqKey="D Arminio Monforte A" first="Antonella" last="D'Arminio Monforte">Antonella D'Arminio Monforte</name></region></country><country name="Australie"><region name="Nouvelle-Galles du Sud"><name sortKey="Law, Matthew G" sort="Law, Matthew G" uniqKey="Law M" first="Matthew G." last="Law">Matthew G. 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