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

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

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Main Authors: Ninutcha Paengsai, Gonzague Jourdain, Nicolas Salvadori, Apichat Tantraworasin, Jean Yves Mary, Tim Roy Cressey, Romanee Chaiwarith, Chureeratana Bowonwatanuwong, Sorakij Bhakeecheep, Natapong Kosachunhanun
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Published: 2020
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http://cmuir.cmu.ac.th/jspui/handle/6653943832/67967
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spelling th-cmuir.6653943832-679672020-04-02T15:12:37Z Recommended First-Line Antiretroviral Therapy Regimens and Risk of Diabetes Mellitus in HIV-Infected Adults in Resource-Limited Settings Ninutcha Paengsai Gonzague Jourdain Nicolas Salvadori Apichat Tantraworasin Jean Yves Mary Tim Roy Cressey Romanee Chaiwarith Chureeratana Bowonwatanuwong Sorakij Bhakeecheep Natapong Kosachunhanun Medicine © 2019 The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America. 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. 2020-04-02T15:12:37Z 2020-04-02T15:12:37Z 2019-09-30 Journal 23288957 2-s2.0-85073503786 10.1093/ofid/ofz298 https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85073503786&origin=inward http://cmuir.cmu.ac.th/jspui/handle/6653943832/67967
institution Chiang Mai University
building Chiang Mai University Library
country Thailand
collection CMU Intellectual Repository
topic Medicine
spellingShingle Medicine
Ninutcha Paengsai
Gonzague Jourdain
Nicolas Salvadori
Apichat Tantraworasin
Jean Yves Mary
Tim Roy Cressey
Romanee Chaiwarith
Chureeratana Bowonwatanuwong
Sorakij Bhakeecheep
Natapong Kosachunhanun
Recommended First-Line Antiretroviral Therapy Regimens and Risk of Diabetes Mellitus in HIV-Infected Adults in Resource-Limited Settings
description © 2019 The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America. 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.
format Journal
author Ninutcha Paengsai
Gonzague Jourdain
Nicolas Salvadori
Apichat Tantraworasin
Jean Yves Mary
Tim Roy Cressey
Romanee Chaiwarith
Chureeratana Bowonwatanuwong
Sorakij Bhakeecheep
Natapong Kosachunhanun
author_facet Ninutcha Paengsai
Gonzague Jourdain
Nicolas Salvadori
Apichat Tantraworasin
Jean Yves Mary
Tim Roy Cressey
Romanee Chaiwarith
Chureeratana Bowonwatanuwong
Sorakij Bhakeecheep
Natapong Kosachunhanun
author_sort Ninutcha Paengsai
title Recommended First-Line Antiretroviral Therapy Regimens and Risk of Diabetes Mellitus in HIV-Infected Adults in Resource-Limited Settings
title_short Recommended First-Line Antiretroviral Therapy Regimens and Risk of Diabetes Mellitus in HIV-Infected Adults in Resource-Limited Settings
title_full Recommended First-Line Antiretroviral Therapy Regimens and Risk of Diabetes Mellitus in HIV-Infected Adults in Resource-Limited Settings
title_fullStr Recommended First-Line Antiretroviral Therapy Regimens and Risk of Diabetes Mellitus in HIV-Infected Adults in Resource-Limited Settings
title_full_unstemmed Recommended First-Line Antiretroviral Therapy Regimens and Risk of Diabetes Mellitus in HIV-Infected Adults in Resource-Limited Settings
title_sort recommended first-line antiretroviral therapy regimens and risk of diabetes mellitus in hiv-infected adults in resource-limited settings
publishDate 2020
url https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85073503786&origin=inward
http://cmuir.cmu.ac.th/jspui/handle/6653943832/67967
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