Protease Inhibitor Use and the Incidence of Diabetes Mellitus in a Large Cohort of HIV-Infected Women

Justman, Jessica; Benning, Lorie; Danoff, Ann; Minkoff, Howard; Levine, Alexandra M.; Greenblatt, Ruth M.; Weber, Kathleen M.; Piessens, Eva; Robison, Esther; Anastos, Kathryn

doi:10.1097/00126334-200303010-00009

Cited by 182 publications

(153 citation statements)

References 15 publications

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“…On the other hand and in line with Guillen and co-workers' findings, we did not observe an association between insulin resistance and ART; even when the ART regimen comprised protease inhibitors. These results differ from those previously reported [6,23]. Moreover, there is convincing evidence that development of insulin resistance and other abnormalities of glucose metabolism in the context of HIV infection can have multiple origins including continuous ART, and inflammatory reactions associated with chronic HIV infection [18,24].…”

Section: Discussioncontrasting

confidence: 79%

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Insulin resistance and associated factors among HIV-infected patients in sub-Saharan Africa: a cross sectional study from Cameroon

Noumegni¹,

Nansseu²,

Moor³

et al. 2018

Pan Afr Med J Conf Proc

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Background: Little is known on the magnitude and correlates of insulin resistance in HIV-infected people in Africa. We determined the prevalence of insulin resistance and investigated associated factors in HIV-infected adult Cameroonians. Methods: We conducted a cross-sectional study at the Yaoundé Central Hospital, Cameroon; during which we enrolled HIV-infected people aged 30 to 74 years with no previous history of cardiovascular disease. An homeostatic model assessment of insulin resistance (HOMA-IR) like index served to assess insulin sensitivity with insulin resistance defined by values of 2.1 or higher. Results: We included 452 patients (20% men). Their mean age was 44.4 ± 9.8 years and 88.5% of them were on antiretroviral therapy (93.3% on first line regimen including Zidovudine, lamivudine and Efavirenz/Nevirapine). Of all participants, 28.5% were overweight, 19.5% had obesity and 2.0% had diabetes. The prevalence of insulin resistance was 47.3% without any difference between patients on ART and those ART-naïve (48.5% vs. 38.5%; p = 0.480). Obesity was the only factor independently associated with insulin resistance (adjusted odds ratio: 2.28; 95% confidence interval: 1.10-4.72). Conclusion: Insulin resistance is present in nearly half of HIV-infected patients in Cameroon despite a low prevalence rate of diabetes, and is associated with obesity.

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Section: Discussioncontrasting

confidence: 79%

“…These metabolic abnormalities seem to be more preponderant among patients on ART, especially those on protease inhibitors-containing regimen [5,6]. The prevalence of insulin resistance in HIV-infected individuals varies between 13 and 47.7% [7].…”

Section: Introductionmentioning

confidence: 99%

Insulin resistance and associated factors among HIV-infected patients in sub-Saharan Africa: a cross sectional study from Cameroon

Noumegni¹,

Nansseu²,

Moor³

et al. 2018

Pan Afr Med J Conf Proc

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“…Process-related measures were: (1) proportion of medical visits with documented blood pressure, (2) whether LDL-cholesterol (LDL-C) was checked yearly and within 6 months of starting new cART, 10 and (3) frequency of hemoglobin A1c measurements. Disease-related measures were: (1) proportion of blood pressure measurements at goal as defined by the 7th Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7); 11 (2) proportion of LDL-C measurements at goal as defined by the 3rd Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (NCEP ATPIII); 12 and (3) proportion of hemoglobin A1c values G7% as recommended by the American Diabetes Association (ADA). 13 "Comorbid hypertension" was defined according to JNC7 criteria; "comorbid dyslipidemia" was defined as a history of lipid-lowering medication use or according to NCEP ATPIII guidelines; "comorbid diabetes" was defined according to ADA definitions.…”

Section: Methodsmentioning

confidence: 99%

“…Increased rates of dyslipidemia, cardiovascular disease, and diabetes are welldocumented, [1][2][3] with multiple factors (inflammation caused by HIV, antiretroviral effects, traditional risk factors, etc.) accounting for these findings.…”

Section: Introductionmentioning

confidence: 99%

Comorbidity-Related Treatment Outcomes among HIV-Infected Adults in the Bronx, NY

et al. 2011

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Aging, HIV infection, and antiretroviral therapy have been associated with increasing rates of chronic comorbidities in patients with HIV. Urban minority populations in particular are affected by both the HIV/AIDS and chronic disease epidemics. Our objectives were to estimate the prevalence of and risk factors for hypertension, dyslipidemia, and diabetes among HIV-infected adults in the Bronx and describe comorbidity-related treatment outcomes. This was a cross-sectional study of 854 HIV-positive adults receiving care at 11 clinics which provide HIV primary care services; clinics were affiliated with a large urban academic medical center. Data on blood pressure (BP), cholesterol, and glycemic control were collected through standardized chart review of outpatient medical records. We found prevalence rates of 26%, 48%, and 13% for hypertension, dyslipidemia, and diabetes, respectively. Older age, obesity, family history, and current protease inhibitor use were consistently associated with comorbidity. Diabetes treatment goals were achieved less often than BP and lipid goals, and concurrent diabetes was a significant predictor for BP and lipid control. In conclusion, major cardiovascular-related comorbidities are prevalent among HIVpositive adults in the Bronx, especially older and obese individuals. Differences exist in comorbidity-related treatment outcomes, especially for patients with concurrent diabetes. Because cardiovascular risk is modifiable, effective treatment of related comorbidities may improve morbidity and mortality in HIV-infected patients.

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“…Compared with HIV-positive women receiving either NRTIs only or no therapy, the risk also increased (1.35%) (p=0.025). 15 The incidence of gestational diabetes has been seen to increase to 7% higher than expected in the general population. 16 Older age and PI use were associated with gestational diabetes in a multivariate analysis (odds ratio (OR) 2.3, 95% confidence interval (CI) 1.0 -5.3).…”

Section: The Cochrane Collaborationmentioning

confidence: 99%

Safety of Antiretrovirals in Pregnancy

Clayden¹

2009

South. Afr. j. HIV med.

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Protease Inhibitor Use and the Incidence of Diabetes Mellitus in a Large Cohort of HIV-Infected Women

Abstract: PI use was associated with a threefold increase in the risk of reporting incident DM. Routine screening for diabetes, particularly among older and heavier patients using PI therapy, is advisable.

Cited by 182 publications

References 15 publications

Insulin resistance and associated factors among HIV-infected patients in sub-Saharan Africa: a cross sectional study from Cameroon

Insulin resistance and associated factors among HIV-infected patients in sub-Saharan Africa: a cross sectional study from Cameroon

Comorbidity-Related Treatment Outcomes among HIV-Infected Adults in the Bronx, NY

Safety of Antiretrovirals in Pregnancy

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