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Antiretroviral Therapy Raises Risk of Diabetes
posted 02/19/04

Exposure to highly active antiretroviral therapy (HAART) appears to raise the risk of diabetes among HIV-infected men, a new study shows.

Todd T. Brown, MD, a postdoctoral fellow in endocrinology at the Johns Hopkins Medical Institutions in Baltimore, Maryland, presented the findings on February 10^th at the 11^th Conference on Retroviruses and Opportunistic Infections (CROI).

"Insulin resistance and hyperglycemia are common among HIV patients and may be related to HAART," he said. "But the actual risks are unclear, with previous studies evaluating risks relying on self-reports of hyperglycemia."

To better define the prevalence and incidence of hyperglycemia and diabetes among HIV-infected patients and explore the factors associated with increased risk, the researchers studied 1,278 men enrolled in the Multicenter AIDS Cohort Study, using data from April 1999 through September 2002. After excluding men with fasting plasma glucose of greater than 105 mg/dL, use of anti-diabetic medications, or a self-reported diagnosis of diabetes, the final cohort consisted of 765 men, 407 of whom were HIV-negative. Of the 358 men who were HIV-positive, 272 men were on HAART.

Hyperglycemia was defined as a fasting plasma glucose level of 110 mg/dL or greater, and diabetes was defined as a level of 126 mg/dL or greater, use of anti-diabetic medication, or a self-reported diagnosis of diabetes.

The study showed that HIV-positive men were 2.61 times more likely to develop hyperglycemia than HIV-negative men, "but the numbers were too small to ascertain the risk associated with HAART," Dr. Brown said.

But men on HAART were 4.57 times more likely to develop diabetes, compared with HIV-negative men, he said. After adjustment for age and body mass index, HIV-positive men on HAART were 2.16 times more likely to develop diabetes than HIV-negative men. When looked at by type of drug, exposure to any protease inhibitor increased diabetes risk 2.38-fold, exposure to stavudine raised risk 2.77-fold, and exposure to efavirenz increased risk 3.16-fold.

"Each of the components of HAART … raised risk, but no one component conveyed any added risk compared with HAART in general," Dr. Brown said. "In other words, we could not identity any one component of HAART responsible for the increased risk."

Study title: Prevalence and Incidence of Pre-Diabetes and Diabetes in the Multicenter AIDS Cohort Study. Abstract 73

Source: Diabetes In Control.com.

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