Hepatitis C is associated with type 2 diabetes mellitus in HIV‐infected persons without traditional risk factors

Abstract

ObjectivesHepatitis C virus (HCV) monoinfection has been linked to type 2 diabetes mellitus (DM). We evaluated the effect of HCV on risk of DM in relation to traditional risk factors such as age, body mass index (BMI) and family history of DM in an HIV-infected population. MethodsThis was a retrospective, cross-sectional study of 1529 HIV-infected out-patients. An adjusted multivariate logistic regression was performed to assess the effect of HCV seropositivity on DM stratified by low and high propensity for DM based on age, BMI and family history. ResultsRace, age, BMI, family history and HCV were associated with DM. Use of protease inhibitors (PIs) was not associated with DM, but HIV/HCV-coinfected patients were less likely to be on PIs than those with HIV infection alone. In a multivariate analysis controlled for race, the association between HCV and DM was stronger in lean, young patients without a family history of DM; the low-risk group. No association between HCV and type 2 DM was seen in patients who were older or overweight or had a family history of DM; the high-risk group. PI use did not affect the association between HCV and DM. ConclusionsHepatitis C is an independent risk factor for type 2 diabetes in young, lean, HIV-infected patients. HIV-infected patients with HCV infection, regardless of whether they are on PIs, should be carefully screened for DM even if traditional risk factors for DM are not present.Keywords: diabetes mellitus, hepatitis C virus, HIV, protease inhibitors, risk factors IntroductionType 2 diabetes mellitus (DM) is a common comorbid condition in those coinfected with HIV and the hepatitis C virus (HCV). Multiple factors may lead to the development of DM in HIV-infected persons. First, patients infected with HIV but not HCV who are taking protease inhibitors (PIs) are at increased risk for developing DM [1][2][3]. Secondly, longer duration of HIV-positive survival as a result of highly active antiretroviral therapy (HAART) leads to an older population which may contribute to the higher prevalence of DM, especially in those with HIV/HCV coinfection [4]. HCV itself has been linked to type 2 DM [5][6][7][8][9][10][11], and the higher prevalence of HCV in HIV-infected persons may also contribute to the increased prevalence of DM in the HIV-infected population [12].The association of HCV and type 2 DM is complex, with some studies suggesting that the higher prevalence of DM is a result of more severe liver disease in both the HCV-and hepatitis B virus (HBV)-infected groups [7,9,[13][14][15][16]. However, other studies have suggested that HCV may be directly involved in the development of type 2 DM or insulin resistance even in those without cirrhosis [8,[17][18][19] 491 HCV-infected persons over the age of 40 years in a nationwide cross-sectional study [11] and then in a longitudinal cohort study found that those with HCV infection were at increased risk for developing DM with increasing age and body mass index (BMI). Another nationwide crosssectional study dividing patients into yo...

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