Background With integrase strand transfer inhibitor (INSTI) use associated with increased body mass index (BMI) and BMI increases associated with higher diabetes mellitus (DM) risk, we explored the relationships between INSTI/non-INSTI regimens, BMI changes, and DM risk. Methods RESPOND participants were included if they had CD4, human immunodeficiency virus (HIV) RNA, and ≥2 BMI measurements during follow-up. Those with prior DM were excluded. DM was defined as a random blood glucose ≥11.1 mmol/L, hemoglobin A1c ≥6.5%/48 mmol/mol, use of antidiabetic medication, or site-reported clinical diagnosis. Poisson regression was used to assess the association between natural log (ln) of time-updated BMI and current INSTI/non-INSTI and their interactions on DM risk. Results Among 20 865 people with HIV included, most were male (74%) and White (73%). Baseline median age was 45 years (interquartile range [IQR], 37–52), with a median BMI of 24 kg/m2 (IQR, 22–26). There were 785 DM diagnoses with a crude rate of 0.73 (95% confidence interval [CI], .68–.78)/100 person-years of follow-up. ln(BMI) was strongly associated with DM (adjusted incidence rate ratio [aIRR], 16.54 per log increase; 95% CI, 11.33–24.13; P < .001). Current INSTI use was associated with increased DM risk (IRR, 1.58; 95% CI, 1.37–1.82; P < .001) in univariate analyses and only partially attenuated when adjusted for variables including ln(BMI) (aIRR, 1.48; 95% CI, 1.29–1.71; P < .001). There were no interactions between ln(BMI), INSTI, and non-INSTI use and DM (P = .130). Conclusions In RESPOND, compared with non-INSTIs, current use of INSTIs was associated with an increased DM risk, which partially attenuated when adjusted for BMI changes and other variables.

中文翻译：

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整合酶链转移抑制剂 – 体重指数和糖尿病风险的相关变化：来自 RESPOND 队列联盟的一项前瞻性研究


背景 整合酶链转移抑制剂 （INSTI） 的使用与体重指数 （BMI） 增加相关，BMI 增加与糖尿病 （DM） 风险增加相关，我们探讨了 INSTI/非 INSTI 方案、BMI 变化和 DM 风险之间的关系。方法 如果 RESPOND 参与者在随访期间有 CD4 、人类免疫缺陷病毒 （HIV） RNA 和 ≥2 BMI 测量值，则将其纳入。既往患有 DM 的患者被排除在外。DM 定义为随机血糖 ≥11.1 mmol/L、血红蛋白 A1c ≥6.5%/48 mmol/mol、使用抗糖尿病药物或现场报告的临床诊断。泊松回归用于评估时间更新的 BMI 的自然对数 （ln） 与当前 INSTI/非 INSTI 之间的关联及其对 DM 风险的交互作用。结果 在纳入的 20 865 例 HIV 感染者中，男性 （74%） 和白人 （73%） 居多。基线中位年龄为 45 岁 （四分位距 [IQR]，37-52），中位 BMI 为 24 kg/m2 （IQR，22-26）。有 785 例 DM 诊断，粗略率为 0.73 （95% 置信区间 [CI]，.68-.78）/100 人年。ln（BMI） 与 DM 密切相关 （调整后的发病率比 [aIRR]，每对数增加 16.54;95% CI，11.33–24.13;P < .001）.目前使用 INSTI 与 DM 风险增加相关（IRR，1.58;95% CI，1.37-1.82;P < .001），并且在调整变量时仅部分衰减，包括 ln（BMI）（aIRR，1.48;95% CI，1.29–1.71;P < .001）.ln（BMI）、INSTI 和非 INSTI 使用与 DM 之间没有相互作用 （P = .130）。结论 在 RESPOND 中，与非 INSTI 相比，当前使用 INSTI 与 DM 风险增加相关，当调整 BMI 变化和其他变量时，这种风险部分减弱。