Triglyceride/HDL ratio and its impact on the risk of diabetes mellitus development during ART.
Our primary aim was to study diabetes mellitus (DM) arising during combination ART (cART) and to attempt to identify associations between these cases and triglycerides (TRG) and the TRG to HDL-cholesterol (TRG/HDL) ratio. Our secondary aim was to analyse the association between DM development and hepatic fibrosis.



This was a retrospective cohort study. Patients from the Icona Foundation study initiating first-line cART between 1997 and 2013 were selected and observed until new-onset DM or most recent clinical follow-up. The predictive value of TRG and TRG/HDL ratio levels on DM was evaluated using multivariable Poisson regression models.



Three-thousand, five-hundred and forty-six patients (males, 73.7%; median age, 38 years; median BMI, 23.1 kg/m(2); and hepatitis C virus antibody positive, 22.1%) were included. Of these, 80 developed DM over 13 911 person-years of follow-up (PYFU), corresponding to 5.7 cases per 1000 PYFU (95% CI = 4.6-7.1). At multivariable analysis, latest TRG/HDL ratio, when high, was associated with significant increases in DM risk [relative risk (RR) = 1.63; 95% CI = 1.32-2.01 per 10 points higher], while current TRG, in contrast, was associated with new-onset DM only at crude analysis. Advanced liver fibrosis (defined as fibrosis-4 index >3.25) was also shown to be an independent risk factor for DM (RR = 2.91; 95% CI = 1.10-7.72).



High TRG/HDL ratio predicted risk of new-onset DM, independently of other traditional risk factors. Furthermore, our findings suggest that advanced hepatic fibrosis, estimated using the fibrosis-4 score, could provide an additional predictor for DM.
Division of Infectious Diseases, Department of Internal Medicine, 'San Gerardo' Hospital, University Milano-Bicocca, Monza, Italy nicolasquillace74@gmail.com.
Nicola
N
Squillace
'Lazzaro Spallanzani' National Institute for Infectious Diseases-IRCCS, Rome, Italy.
Patrizia
P
Lorenzini
Division of Infectious Diseases, Department of Internal Medicine, 'San Gerardo' Hospital, University Milano-Bicocca, Monza, Italy.
Giuseppe
G
Lapadula
Division of Infectious Diseases, Department of Internal Medicine, 'San Gerardo' Hospital, University Milano-Bicocca, Monza, Italy.
Alessandra
A
Bandera
Royal Free Centre for HIV Medicine & Department of Primary Care and Population Sciences, Royal Free and University College Medical School, Royal Free Campus, London, UK.
Alessandro
A
Cozzi-Lepri
Infectious Diseases, Department of Biomedical and Clinical Science Luigi Sacco, University of Milan, Milan, Italy.
Stefano
S
Rusconi
Infectious Disease Unit, Niguarda Cà Granda Hospital, Milan, Italy.
Massimo
M
Puoti
Department of Infectious Diseases, San Raffaele Scientific Institute, University Vita-Salute San Raffaele, Milan, Italy.
Antonella
A
Castagna
'Lazzaro Spallanzani' National Institute for Infectious Diseases-IRCCS, Rome, Italy.
Andrea
A
Antinori
Division of Infectious Diseases, Department of Internal Medicine, 'San Gerardo' Hospital, University Milano-Bicocca, Monza, Italy.
Andrea
A
Gori
San Paolo University Hospital, Milan, Italy.
Antonella
A
d'Arminio Monforte
D000328:Adult; D044966:Anti-Retroviral Agents / Q000009:adverse effects* / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D018937:Hepatitis C Antibodies / Q000097:blood; D006801:Humans; D008075:Lipoproteins, HDL / Q000097:blood*; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D014280:Triglycerides / Q000097:blood*
D044966:Anti-Retroviral Agents; C034396:HDL-triglyceride; D018937:Hepatitis C Antibodies; D008075:Lipoproteins, HDL; D014280:Triglycerides