Background Pre-diabetes is associated with proteinuria, a risk factor for chronic kidney disease. While people living with HIV (PWH) have a higher risk of proteinuria than people without HIV (PWOH), it is unknown whether incident proteinuria differs by HIV serostatus among pre-diabetic persons. Methods Urine protein-to-creatinine ratio (PCR) was measured at semi-annual visits among men in the Multicenter AIDS Cohort Study since April 2006. Men with pre-DM on or after April 2006 and no prevalent proteinuria or use of anti-diabetic medications were included. Pre-diabetes was defined as fasting glucose (FG) of 100-125 mg/dL confirmed within a year by a repeat FG or hemoglobin A1c 5.7–6.4%. Incident proteinuria was defined as PCR > 200 mg/g, confirmed within a year. We used Poisson regression models to determine whether incident proteinuria in participants with pre-diabetes differed by HIV serostatus and, among PWH, whether HIV-specific factors were related to incident proteinuria. Results Between 2006 and 2019, among 1276 men with pre-diabetes, 128/613 PWH (21%) and 50/663 PWOH (8%) developed proteinuria over a median 10-year follow-up. After multivariable adjustment, the incidence of proteinuria in PWH with pre-diabetes was 3.3 times [95% CI: 2.3–4.8 times] greater than in PWOH (p < 0.01). Among PWH, current CD4 count <500 cells/mm3 (p < 0.01) and current use of protease inhibitors (p = 0.03) were associated with incident proteinuria, while lamivudine and integrase inhibitor use were associated with a lower risk. Conclusion Among men with pre-DM, the risk of incident proteinuria was 3 times higher in PWH. Strategies to preserve renal function are needed in this population.

中文翻译：

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糖尿病前期男性的蛋白尿发生率因 HIV 血清状态而异：多中心艾滋病队列研究

背景 糖尿病前期与蛋白尿有关，蛋白尿是慢性肾病的危险因素。虽然艾滋病毒感染者 (PWH) 的蛋白尿风险高于未感染艾滋病毒的人 (PWOH)，但尚不清楚糖尿病前期人群中发生的蛋白尿是否因艾滋病毒血清状态而异。方法 自 2006 年 4 月起，每半年访视一次多中心艾滋病队列研究，对男性进行尿蛋白与肌酐比值 (PCR) 测量。2006 年 4 月或之后患有糖尿病前期且无普遍蛋白尿或未使用抗糖尿病药物的男性药物也包括在内。糖尿病前期的定义是一年内重复空腹血糖 (FG) 100-125 mg/dL 或糖化血红蛋白 5.7-6.4%。发生蛋白尿定义为PCR＞1。 200 mg/g，一年内得到证实。我们使用泊松回归模型来确定糖尿病前期参与者的蛋白尿是否因 HIV 血清状态而异，以及在感染者中，HIV 特异性因素是否与蛋白尿相关。结果 2006 年至 2019 年间，在 1276 名糖尿病前期男性中，128/613 例 PWH (21%) 和 50/663 例 PWOH (8%) 在中位 10 年随访中出现蛋白尿。经过多变量调整后，糖尿病前期 PWH 中蛋白尿的发生率是 PWOH 中的 3.3 倍 [95% CI：2.3-4.8 倍]（p < 0.01）。在 PWH 中，当前 CD4 计数 < 500 个细胞/mm3 (p < 0.01) 和当前使用蛋白酶抑制剂 (p = 0.03) 与蛋白尿事件相关，而拉米夫定和整合酶抑制剂的使用与较低风险相关。结论 在患有糖尿病前期的男性中，PWH 期间发生蛋白尿的风险高出 3 倍。该人群需要采取保护肾功能的策略。