The Effects of Opiate Use and Hepatitis C Virus Infection on Risk of Diabetes Mellitus in the Women's Interagency HIV Study

Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
JAIDS Journal of Acquired Immune Deficiency Syndromes (Impact Factor: 4.56). 02/2010; 54(2):152-9. DOI: 10.1097/QAI.0b013e3181d0c911
Source: PubMed


Opiate use is common in HIV-infected and hepatitis C virus (HCV)-infected individuals, however, its contribution to the risk of diabetes mellitus is not well understood.
Prospective study of 1713 HIV-infected and 652 HIV-uninfected participants from the Women's Interagency HIV Study between October 2000 and March 2006. Diabetes defined as fasting glucose > or =126 mg/dL, self report of diabetes medication use, or confirmed diabetes diagnosis. Opiate use determined using an interviewer-administered questionnaire. Detectable plasma HCV RNA confirmed HCV infection.
Current opiate users had a higher prevalence of diabetes (15%) than nonusers (10%, P = 0.03), and a higher risk of incident diabetes (adjusted relative hazard: 1.58, 95% confidence interval: 1.01 to 2.46), after controlling for HCV infection, HIV/antiretroviral therapy status, and diabetes risk factors including age, race/ethnicity, family history of diabetes, and body mass index. HCV infection was also an independent risk factor for diabetes (adjusted relative hazard: 1.61, 95% confidence interval: 1.02 to 2.52). HCV-infected women reporting current opiate use had the highest diabetes incidence (4.83 cases per 100 person-years).
Among women with or at-risk for HIV, opiate use is associated with increased diabetes risk independently of HCV infection. Diabetic screening should be part of care for opiate users and those infected with HCV.

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Available from: Patricia S Latham, Jan 21, 2014
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    • "Twenty-five to 40% of HIV-infected individuals in the United States and Europe are co-infected with HCV. In these populations, HCV co-infection is associated with increased rates of lipodystrophy [8,9], hepatic steatosis [10-12], and insulin resistance [9,13,14], but lower total cholesterol (TC) and low-density lipoprotein cholesterol (LDL) [15-17], particularly in patients infected with HCV genotype 3 [11,12,18]. In HCV mono-infected individuals, altered cholesterol metabolism is associated with hepatic steatosis, advanced hepatic fibrosis, and poor responses to interferon-based therapy [19-21]. "
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    • "Risk was not altered by presence of liver damage as measured by ALT and AST levels [68]. A large prospective study of HIV-infected and uninfected women also found that HCV infection and higher HCV RNA levels were associated with incident diabetes, suggesting that HCV-infected patients should be screened to diabetes [69]. "
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