RESUMO

OBJECTIVE: Diabetes mellitus (DM) is associated with lower antiretroviral (ART) drug exposure among persons with HIV (PWH) compared to PWH without DM. The association between DM and virologic control in PWH, however, remains unknown. METHODS: We included participants in the Multicenter AIDS Cohort Study/Women's Interagency HIV Study Combined Cohort Study (MWCCS) who had initiated ART between 1999 and 2020 and had a suppressed HIV viral load (≤200 copies/mL) within 1 year of ART initiation. We compared the frequency of incident HIV viremia (HIV-1 RNA >200 copies/mL) between adult PWH with and without DM. Poisson regression was used to examine the rate of incident viremia based on the diagnosis of DM among PWH. DM was defined as two consecutive fasting glucose measurements ≥126 mg/dL, use of anti-diabetic medications, pre-existing DM diagnosis, or a confirmed HbA1c >6.5%. RESULTS: 1,061 women (112 with DM, 949 without DM) and 633 men (41 with DM, and 592 without DM) were included in the analysis. The relative rate (RR) of incident HIV viremia for women with HIV and DM was lower when compared to women without DM (0.85 [95% CI: 0.72-0.99]; p = 0.04). The RR of incident viremia for women with uncontrolled DM (HbA1c>7.5%) was higher when compared to women with controlled DM (HbA1c <7.5%) (1.46 [95%CI: 1.03-2.07]; p = 0.03). In contrast, the RR of incident viremia for men with HIV and DM was not statistically different compared to men without DM (1.2 [95%CI: 0.96- 1.50]; p = 0.12). The results were stratified by adherence levels (100%, 95-99%, and less than 95% based on self-report). CONCLUSIONS: Women with DM who are highly adherent to ART (100% self-reported adherence) have a lower risk of viremia compared to women with HIV without DM. However, women with poorly controlled DM were at higher risk of HIV viremia than women with controlled DM. Further research is necessary to understand the impact of sex, DM, and ART adherence on HIV viremia.

RESUMO

Objetivo: Evaluar la eficacia del danazol para el tratamiento de la trombocitopenia asociada con el virus de la inmunodeficiencia humana tipo 1 (HIV-1). Pacientes y Métodos: Estudio retrospectivo, diseño serie de casos. Se identificaron 8 pacientes con trombocitopenia asociada a infección con HIV-1 que fueron tratados con danazol (300-800 mg/día) por más de 3 meses. El seguimiento fue de 3 meses a 2 años. Se definió respuesta favorable al tratamiento como un incremento en el recuento de plaquetas por encima del 25 por ciento con referencia a los valores pre-tratamiento. Resultados: El recuento de plaquetas promedio(ñ desviación estándar) antes de la terapia con danazol fue de 51ñ24 x 10/L, con un rango de 19-88 x 10/L.Siete (87 por ciento) de los 8 pacientes tuvieron respuestas favorables al danazol. Los recuentos promedio a 12 y 24 meses de terapia fueron 104+108 x 10/L, y 112ñ28 x 10/L, respectivamente. Se observó una tendencia al incremento de los recuentos plaquetarios durante el tratamiento con danazol. Conclusión: Danazol puede ser de utilidad en el tratamiento de la trombocitopenia asociada a HIV-1.

Assuntos