Risk factors for incident diabetes mellitus among HIV‐infected patients receiving combination antiretroviral therapy in Taiwan: a case–control study

Abstract

ObjectivesRecent studies suggest that patients with HIV infection are at increased risk for incident diabetes mellitus (DM). We investigated the incidence and risk factors of DM among HIV-infected patients receiving combination antiretroviral therapy (CART) in Taiwan. MethodsIncident cases of DM were identified among HIV-infected patients at the National Taiwan University Hospital between 1993 and 2006. A retrospective case-control study was conducted after matching cases with controls for sex, age at HIV diagnosis, year of HIV diagnosis, mode of HIV transmission and baseline CD4 lymphocyte count. A multivariate analysis was performed to identify risk factors for incident DM among HIV-infected patients. ResultsIn 824 HIV-infected patients eligible for analysis, 50 cases of incident DM were diagnosed, resulting in an incidence of 13.1 cases per 1000 person-years of follow-up. In total, 100 matched controls were identified. Risk factors for incident DM were a family history of DM [odds ratio (OR) 2.656; 95% confidence interval (CI) 1. 209-5.834], exposure to zidovudine (OR 3.168;) and current use of protease inhibitors (OR 2.528; 95% CI 1.186-5.389). ConclusionsIncident DM was associated with a family history of DM, exposure to zidovudine and current use of protease inhibitors in HIV-infected patients receiving CART in Taiwan.Keywords: antiretroviral therapy, case-control study, diabetes mellitus, HIV infection IntroductionCombination antiretroviral therapy (CART) has greatly improved survival in patients with HIV infection [1,2]. However, as HIV-infected patients exposed to antiretroviral agents experience prolonged survival and ageing, we have observed the emergence of CART-associated metabolic complications that include impaired glucose tolerance, diabetes mellitus (DM) and lipid disorders, which may subsequently result in increased risk for cardiovascular diseases [3][4][5][6].Glucose intolerance and DM are becoming more common in HIV-infected patients in the era of CART [5,[7][8][9]. Previous studies reported a 6-7% risk of incident DM among patients receiving protease inhibitors (PIs) [9]. Cohort studies showed that HIV-infected individuals on CART had a higher incidence of DM than those not on CART or their HIV-uninfected counterparts [10][11][12]. The incidence of DM among patients receiving CART shows wide variation, from 4.4 per 1000 person-years of followup (PYFU) in the Swiss Cohort Study to 34 per 1000 PYFU in the Women's Interagency HIV Study (WIHS) and 47 per 1000 PYFU in the Multicenter AIDS Cohort Study (MACS) [11][12][13][14]. The discrepancies may result from the enrolment of study populations of different race and ethnicity and from differences in the definition of DM [11][12][13][14].With respect to the factors associated with the development of DM in HIV-infected individuals receiving CART, several cohort studies yielded inconsistent results in terms of the relationship between DM and exposure to specific Correspondence: Dr Chien-Ching Hung, Department of Internal Medicine, National Taiwan U...

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

“…25 kg/m 2 ) and have one or more additional risk factors for diabetes [25]. HIV-infected patients have additional risks associated with drug treatment [2][3][4][5][6][7][8][9][10] that make them candidates for proactive screening. The OGTT revealed that 11% of our cohort of (predominantly male) Caucasian patients with long-standing HIV infection had IGT or DM, undiagnosed on the basis of FPG levels; among the considered factors, only CD4 cell counts and HOMA-IR predicted abnormal glucose tolerance.…”

“…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]. 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.…”

How Sweet It Is? Susceptibility to Diabetes Mellitus in HIV-1 Treatment

“…In this case-control study, an odds ratio of 3.3 was found for family history of T2D, in age-, gender-and ethnicity-matched controls [22]. A Taiwanese study recently found that family history was the strongest predictor of incident T2D (RR: 2.66), as discussed later [23]. By contrast, two studies have found no increased susceptibility in subjects with a family history of T2D [11,24].…”

“…Prospective observational data from Taiwan indicate an incidence of 13 T2D cases per 1000 person-years, with an average of 4.6 years followup [23]. Screening was by fasting glucose alone; risks for incident diabetes mellitus were family history, hypertriglyceridemia, current PI use and past exposure to zidovudine [23]. These early data suggest sub-Saharan and Asian populations may be at heightened risk of metabolic complications including T2D; further studies are awaited.…”

“…Within the relatively short time frame of this study and (relative to western nations) an absence of obesity-promoting environmental accelerators, T2D developed in 8% of subjects, with lipohypertrophy in 24%, lipoatrophy in 9%, hypercholesterolaemia in 35% and metabolic syndrome in 13% [27]. Prospective observational data from Taiwan indicate an incidence of 13 T2D cases per 1000 person-years, with an average of 4.6 years followup [23]. Screening was by fasting glucose alone; risks for incident diabetes mellitus were family history, hypertriglyceridemia, current PI use and past exposure to zidovudine [23].…”