Detecting impaired glucose tolerance or type 2 diabetes mellitus by means of an oral glucose tolerance test in HIV-infected patients

Abstract

ObjectiveAs a proactive diagnosis of diabetes mellitus (DM) may prevent the onset of severe complications, we used an oral glucose tolerance test (OGTT) to check for impaired glucose tolerance (IGT) and DM in patients with long-standing HIV infection and long durations of exposure to antiretroviral drugs with normal fasting plasma glucose (FPG) levels. MethodsThis was a cross-sectional, single-centre study. The homeostatic model assessment for insulin resistance (HOMA-IR) and 2-h post-load glucose levels were used to evaluate patients with known HIV-1 infection since before 1988 and no previous diagnosis of DM for whom data on hepatitis C virus (HCV) and hepatitis B virus (HBV) infection were available. ResultsEighty-four Caucasian patients [67 (80%) male; median age 45.7 years; range 43.8-49.1 years] were able to be evaluated; 65 (77%) were coinfected with HCV, and seven (8%) were coinfected with HBV. Median (interquartile range [IQR]) exposure to antiretrovirals was 12.8 (10.4-16.5) years. Fifteen patients (18%) had a previous AIDS-defining event, 64 (76%) had HIV RNAo50 copies/mL, and the median (IQR) CD4 count was 502 (327-628) cells/mL. The median [IQR] FPG was 81 mg/dL (4.5 mmol/ L) [75-87 mg/dL (4.2-4.8 mmol/L)], and the median (IQR) HOMA-IR was 2.82 (1.89-4.02). After OGTT, nine patients (11%) were diagnosed as having IGT (6) or DM (3). A first multivariable analysis showed that CD4 cell count (P 5 0.038) and HOMA-IR (P 5 0.035) were associated with IGT or DM, but a second model including only the variables with a P-value of o0.2 in the univariable analysis (CD4 cell count, HBV coinfection, and HOMA-IR) found that only HOMA-IR independently predicted IGT or DM. ConclusionsIn patients with long-standing HIV infection and normal FPG levels, an OGTT can reveal IGT or DM.Keywords: antiretroviral therapy, diabetes, HIV, insulin resistance, oral glucose tolerance test IntroductionDiabetes mellitus (DM) is a group of metabolic diseases characterized by hyperglycaemia resulting from defects in insulin secretion, insulin activity or both. The cause of type 1 diabetes is an absolute insulin deficiency, whereas that of type 2 diabetes is a combination of resistance to insulin activity and an inadequate compensatory insulin secretion response [1]. Hyperglycaemia, insulin resistance and DM have been associated with treatment with protease inhibitors (PIs), nucleoside reverse transcriptase inhibitors (NRTIs) and nonnucleoside reverse transcriptase inhibitors (NNRTIs) in HIV-infected patients [2][3][4][5][6][7][8][9][10]. DOI: 10.1111DOI: 10. /j.1468DOI: 10. -1293DOI: 10. .2010 (2011), 12, 109-117 109 Antiretroviral drugs, such as some PIs [11,12] and some NRTIs [13,14], and uncontrolled HIV replication [15] both increase the risk of myocardial infarction. This leads to a higher risk of coronary artery disease in HIV-infected patients than in the age-matched general population [16,17], and more than double the risk of myocardial infarction in HIV-infected patients with DM [18]..x r 2010 British HIV Association HI...

Multicenter Cohort Study of Diabetes Mellitus and Impaired Fasting Glucose in HIV-Infected Patients in China

“…Unlike previous studies, 18,20,48,62,63 we did not find an association between BMI, CD4 + cell count, or HIV viral load and rates of DM. Our study population had lower BMI and baseline CD4 + count (Table 1), which may have limited our ability to detect an association between these variables and DM or IFG.…”

Diabetes prevalence by HbA1c and oral glucose tolerance test among HIV-infected and uninfected Tanzanian adults

“…The association of CD4 count with diabetes suggests that immune impairment resulting from HIV infection may magnify the risk of glucose dysregulation. Low CD4 count has previously been associated with diabetes in HIV-infected individuals [41] and helps explain the links between infectious and non-communicable diseases. Physical activity greater than 600 metabolic equivalents per week and an upper tertile of handgrip strength in our study were associated with reduced risk of diabetes.…”

Dysregulation of glucose metabolism in HIV patients: epidemiology, mechanisms, and management

“…Studies exploring the associations of CD4 cell count with abnormal glucose levels in HIV patients show inconsistent results. Low CD4 cell count was associated with IGT and DM in patients co-infected with HIV, hepatitis C and hepatitis B virus [67]. El-Sadr et al reported an inverse relationship between CD4 counts and insulin resistance in HIV patients, but no relationship between CD4 counts and fasting glucose concentrations [2].…”

“…HbA1c should not be used for diagnostic purposes in HIV patients as it may underestimate glycemia, especially among patients on NRTIs; this may be a result of NRTI-induced macrocytosis [102]. Additionally, the oral glucose tolerance test may be used to detect IGT or DM in selected HIV patients who have a normal fasting glucose [67]. …”