Diabetes risk in HIV infection and antiretroviral therapy: A systematic review and meta-analysis of prospective cohort evidence

IF 3.2 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine Pub Date : 2026-08-03 Epub Date: 2026-05-10 DOI:10.1111/hiv.70256

Xuanlan Li, Kang Li, Yuxuan Li, Yue Zhao, Yingqiong Huang, Jun Luo, Li Jiang, Sisi Li, Juan Jing, Chuanyi Ning

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Abstract

Objectives

To quantify the incidence rate (IR) of diabetes in people living with HIV (PLWH), assess disparities relative to HIV-negative individuals and clarify the associations of antiretroviral therapy (ART) exposure and treatment duration with diabetes incidence.

Methods

We searched PubMed up to July 20, 2025, for prospective cohort studies including PLWH aged ≥18 with ≥6 months of follow-up and reported diabetes incidence. Two reviewers independently assessed study quality using the Newcastle-Ottawa Scale and extracted data. A random-effects model estimated pooled incidence rates and subgroup differences. Meta-regression was performed to evaluate study-level associations between ART duration and diabetes incidence.

Results

Thirty-one studies contributed 1 230 314 person-years (PY) of follow-up. The IR in PLWH was 12.98 cases per 1000 PY (95% CI: 10.97–14.98). No significant difference was observed between PLWH (12.97 cases per 1000 PY) and HIV-negative individuals (12.67 cases per 1000 PY; p = 0.9597), although this comparison was based on a limited number of studies. However, incidence among PLWH on ART (14.05 cases per 1000 PY) was significantly higher than in those not on ART (7.42 cases per 1000 PY; p = 0.0179). Each year of ART exposure was associated with an increase of 0.354 cases per 1000 PY in univariable meta-regression (p = 0.008). In multivariable meta-regression, the association between ART duration and diabetes incidence remained significant after adjustment for mean age (p = 0.038), while age was also independently associated with higher incidence (p < 0.001).

Conclusions

Diabetes incidence in PLWH is substantial and varies across regions and diagnostic definitions. Evidence comparing PLWH with HIV-negative individuals remains limited. ART exposure and longer ART duration are associated with higher diabetes incidence, highlighting the importance of routine metabolic screening in long-term HIV care.

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HIV感染和抗逆转录病毒治疗中的糖尿病风险：前瞻性队列证据的系统回顾和荟萃分析。

目的：量化艾滋病毒感染者（PLWH）中糖尿病的发病率（IR），评估相对于艾滋病毒阴性个体的差异，并阐明抗逆转录病毒治疗（ART）暴露和治疗时间与糖尿病发病率的关系。方法：我们检索PubMed截至2025年7月20日的前瞻性队列研究，包括年龄≥18岁，随访≥6个月的PLWH和报告的糖尿病发病率。两名评论者使用纽卡斯尔-渥太华量表独立评估研究质量并提取数据。随机效应模型估计合并发病率和亚组差异。采用meta回归评估研究水平的抗逆转录病毒治疗持续时间与糖尿病发病率之间的关联。结果：31项研究共随访1 230 314人年（PY）。PLWH的IR为12.98例/ 1000 PY （95% CI: 10.97-14.98）。PLWH（每1000 PY 12.97例）和hiv阴性个体（每1000 PY 12.67例，p = 0.9597）之间没有显著差异，尽管这种比较是基于有限数量的研究。然而，接受ART治疗的PLWH发病率（14.05例/ 1000 PY）显著高于未接受ART治疗的PLWH（7.42例/ 1000 PY； p = 0.0179）。在单变量元回归中，ART暴露每年与每1000 PY增加0.354例相关（p = 0.008）。在多变量荟萃回归中，在调整平均年龄后，抗逆转录病毒治疗持续时间与糖尿病发病率之间的相关性仍然显著（p = 0.038），而年龄也与较高的发病率独立相关(p结论：PLWH中的糖尿病发病率很大，并且在不同地区和诊断定义中存在差异。将PLWH与hiv阴性个体进行比较的证据仍然有限。抗逆转录病毒治疗暴露和较长的抗逆转录病毒治疗持续时间与较高的糖尿病发病率相关，这突出了常规代谢筛查在长期艾滋病毒治疗中的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

HIV Medicine 医学-传染病学

CiteScore

5.10

自引率

10.00%

发文量

167

审稿时长

6-12 weeks

期刊介绍： HIV Medicine aims to provide an alternative outlet for publication of international research papers in the field of HIV Medicine, embracing clinical, pharmocological, epidemiological, ethical, preclinical and in vitro studies. In addition, the journal will commission reviews and other feature articles. It will focus on evidence-based medicine as the mainstay of successful management of HIV and AIDS. The journal is specifically aimed at researchers and clinicians with responsibility for treating HIV seropositive patients.