- 期刊
Treatment of Acquired Diabetes Mellitus in People Living with Human Immunodeficiency Virus: A Review
感染人類免疫缺乏病毒患者罹患糖尿病時之治療：文獻回顧
摘要
A higher incidence of new-onset diabetes mellitus (NOD) has been consistently observed in people living with HIV (PLHIV) after receiving highly active antiretroviral therapy (HAART). Most NOD in PLHIV occur after use of HAART and both insulin resistance and impaired β-cell insulin secretion have been found to underlie the disturbed glucose metabolism. The use of glycated hemoglobin (HbA1c) to diagnose or screen DM has been noted to significantly underestimate glycemia status and to have the least yield when compared to using standard oral glucose tolerance test (OGTT) or fasting glucose levels, and should be interpreted with caution. Low hemoglobin values, or hemolysis that causes shortened erythrocyte lifespan have been associated with lower HbA1c values. For better yield of making earlier diagnosis, the conjunction of HbA1c with either fasting plasma glucose levels or standard OGTT is thus recommended in HIV-infected patients. Treatment of DM according to the contemporary guidelines is practical but caution must be taken when there could exist HAART-associated mitochondrial toxicity which may result in buildup of lactic acid, in which case metformin use is contraindicated. HAART-induced hepatotoxicity should be evaluated before prescription of thiazolidinedione. The DPP4 inhibitors have a safe profile regarding immune or virological status, but the dose needs to be reduced when co-administered with a CYP3A4/5 inhibitor (such as protease inhibitors) due to altered plasma concentration profile of the gliptins. With increasing incidence of DM among PLHIV receiving HAART, clinicians are encouraged to keep high profile of clinical vigilance to ensure an appropriate management for patients who may suffer from a new disease while having been treated for an existing one. An understanding of the underlying pathophysiological processes of glucose dysmetabolism linked to antiretroviral therapy will help clinicians treat their patients in a more competent manner.
並列摘要
隨著醫學研究對於「人類免疫缺乏病毒」的日漸瞭解，因其而罹患「後天免疫缺乏症候群」的患者得以獲得有效的抗病毒藥物治療，不僅因此可避免各類致命的伺機性感染，同時壽命亦隨之延長。這些得到適當治療的病患已隨著大眾逐漸邁入高齡化的時代，因此伴隨老化而來的非傳染性疾病漸次浮現，較顯著者如糖尿病，及伴隨其而來的心血管病變風險因子，皆需在醫療及公共衛生層面上另外加以關注。感染人類免疫缺乏病毒者在持續接受高效能抗愛滋病毒藥物治療的時期，在諸多流行病學的研究已被證實某些藥物較易導致糖尿病的發生。實驗室的研究發現：藥物所導致胰島素阻抗性的發生及胰島素分泌能力下降，是引致血糖無法保持正常代謝、甚至進展成糖尿病的主要病生理機制。在感染人類免疫缺乏病毒患者之糖尿病篩查或診斷，建議勿以糖化血色素之測量為主要參考依據，因為患者的紅血球組成異常易低估真實的血糖濃度，此時應用口服葡萄糖耐量測驗較為準確。處方治療糖尿病的各類藥物時，其選擇與使用原則與一般糖尿病患族群無太大差異，但須注意當與其他抗病毒藥物同時使用時，需有特殊考量，以避免因藥物交互作用而產生副作用，在臨床考量上值得注意。