Brown TT, Cole SR, Li X, Kingsley LA, Palella FJ, Riddler SA, et al. Antiretroviral therapy and the prevalence and incidence of diabetes mellitus in the Multicenter AIDS Cohort Study

Department of Medicine, School of Medicine, The Johns Hopkins University, Baltimore, MD, USA.
Archives of Internal Medicine (Impact Factor: 17.33). 06/2005; 165(10):1179-84. DOI: 10.1001/archinte.165.10.1179
Source: PubMed


The risk of diabetes mellitus (DM) in human immunodeficiency virus (HIV)-infected patients receiving highly active antiretroviral therapy (HAART) has not been well defined.
We conducted an analysis in the Multicenter AIDS Cohort Study to determine the prevalence and incidence of DM in this cohort of HIV-infected and HIV-seronegative men. Prevalence analysis included 1278 men (710 HIV seronegative and 568 HIV infected, 411 receiving HAART) with fasting glucose concentration determinations at baseline. Incidence analysis included 680 of these 1278 men who at the baseline visit had a fasting glucose concentration of 98 mg/dL (5.4 mmol/L) or less, no self-reported history of DM, and no self-reported use of antidiabetic medication. Diabetes mellitus was defined as a fasting glucose concentration of 126 mg/dL (7 mmol/L) or higher, self-reported diagnosis of DM, or self-reported use of antidiabetic medication.
Fifty-seven (14%) of the 411 HIV-infected men using HAART at the baseline visit had prevalent DM compared with 33 (5%) of the 711 HIV-seronegative men (prevalence ratio = 4.6; 95% confidence interval, 3.0-7.1, adjusted for age and body mass index [calculated as weight in kilograms divided by the square of height in meters]). The rate of incident DM was 4.7 cases per 100 person-years among HIV-infected men using HAART compared with 1.4 cases per 100 person-years among HIV-seronegative men (rate ratio = 4.11; 95% confidence interval, 1.85-9.16, adjusted for age and body mass index), during the 4-year observation period, based on a median follow-up of 2.3 years.
The incidence of DM in HIV-infected men with HAART exposure was greater than 4 times that of HIV-seronegative men, representing a risk that is higher than previous estimates.

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    • "In Botswana, the prevalence of raised BP was twice as much among PLWHIV compared to the general population [23]. The incidence of diabetes mellitus is fourfold among HIV-infected men on ART compared to HIV negative men [24]. HIV infection has also been associated with incidence of stroke, for example, the HIV prevalence among patients with stroke in Malawi was 48% [25] and in Tanzania was 20.9% and the mean age was lower among stoke patients with HIV infection compared to their HIV negative counterparts [26]. "
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    ABSTRACT: Background HIV and Non communicable diseases (NCDs) are major problem of public health importance in developing countries. This study was conducted to explore and establish information on the magnitude, distribution of NCDs risk factors among people living with HIV (PLWHIV) which is scarce in Tanzania. Method A cross sectional study was conducted to PLWHIV from 12 care and treatment clinics in Dar es Salaam and Mbeya regions from October 2011 to February 2012. Data on demographic characteristics, NCD risk factors including behavioral, biochemical tests and physical measurements was collected from PLWHIV. Results Of 754 PLWHIV recruited, 671(89.0%) consented to participate in the study and 354/671(52.8%) were on antiretroviral therapy (ART). The following NCD risk factors: raised blood levels of low density lipoprotein (61.3% vs 38.7%, p < 0.001) total cholesterol (TC) (71.6% vs 28.4%, p < 0.001) and triglyceride (67.0% vs 33.0%, p = 0.001) as well as overweight/obesity (61.1% vs 38.9%, p = 0.010), abnormal waist circumference (61.7% vs 38.3%, p < 0.001) and being aged >40 years (63.3% vs 36.7%, p < 0.001) were more prevalent among PLWHIV on ART than ART naïve. The prevalence of Diabetes mellitus among PLWHIV was 4.2% and was slightly high among those ART naïve (4.7% vs 3.7%). The prevalence of hypertension was 26.2% and was high among those on ART (30.0% vs 21.9%, p = 0.010). Being aged >40 years (AOR = 2.52, 95% CI 1.37-4.63), abnormal waist circumference (AOR = 2.37 95% CI 1.13-5.00), overweight/obesity (AOR = 2.71, 95% CI 1.26-5.84) and male sex (AOR = 1.17, 1.02-4.20) were the predictors of hypertension among patients on ART while raised TC (AOR = 1.47 (1.01-2.21) and being aged >40 years (AOR = 3.42, 95% CI 2.06-5.70) were predictors for hypertension among ART naïve patients. Conclusion This study has revealed that the magnitude of NCD risk factors is significantly higher among PLWHIV on ART than those not on ART. Initiating and strengthening of interventions for minimizing preventable NCD risks should be considered when initiating ART among PLWHIV. Regular monitoring of NCD risk factors is of paramount importance among ART patients.
    Full-text · Article · Sep 2014 · BMC Public Health
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    • "In the Denmark study, Rasmussen et al found HIV-infected individuals did not have an increased risk of developing diabetes mellitus compared to HIV-uninfected population (3.70 vs. 3.87/1000 person-years) [38]. The discrepancy of incidence of DM in the published studies may be due to differences in demographic factors such as age, gender and race, exposure duration to cART and regimens of cART used [39], [40]. "
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    ABSTRACT: Background With the widespread use of combination antiretroviral therapy (cART), life expectancy of HIV-infected patients has significantly prolonged. An increasing number of HIV-infected patients are aging and concurrent use of medications are not uncommon for management of metabolic complications and cardiovascular diseases related to aging and prolonged exposure to cART. Methods We reviewed medical records of all HIV-infected patients aged 40 years or older who had been followed at a university hospital for HIV care in Taiwan between January and December 2013. A standardized case record form was used to collect information on demographics and clinical characteristics, comorbidity, cART, and concurrent medications. Results During the study period, 610 patients aged 40 to 49 years (mean, 44.1) and 310 aged 50 years or older (mean, 58.8) sought HIV care at this hospital. Compared with patients aged 40 to 49 years, those aged 50 years or older were significantly more likely to be female (15.9% vs 3.8%); to have received cART (97.7% vs 94.8%) and a lower plasma HIV RNA load (1.6 vs 1.7 log10 copies/ml); and to have diabetes mellitus (18.4% vs 4.6%), hypertension (31.0% vs 10.8%), hyperlipidemia (29.4% vs 11.6%), coronary artery disease (6.8% vs 0.5%), and an estimated glomerular filtration rate <60 ml/min/1.73 m2 (11.5% vs 2.7%); and were significantly less likely to have syphilis. Other than HIV infection, patients aged 50 years or older were more likely to have been receiving two or more concurrent medications than those aged 40 to 49 years (22.9% vs 6.4%). Conclusions Our findings show a significant proportion of the HIV-infected patients aged 50 years or older have multiple comorbidities that may increase the risk for cardiovascular and renal complications. Issues of poly-pharmacy among the HIV-infected patients who are aging should be addressed to ensure adherence and minimize drug-drug interactions.
    Full-text · Article · Aug 2014 · PLoS ONE
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    • "As a result, HIV-positive patients have increasing morbidity and mortality from other chronic conditions including diabetes mellitus (DM), hypertension (HTN), and cardiovascular disease [1,2]. DM and HTN are common in HIV-positive patients, with reported DM prevalence in HIV ranging from 2-14% [3,4] and HTN prevalence reported at 31.7% (56.4% in HIV-infected men older than 50) [5]. The prevalence of DM and HTN increases with increasing age. "
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    ABSTRACT: People with HIV are living longer with potent antiretroviral therapy (ART), and HIV is increasingly complicated by other chronic medical comorbidities. The objective of this study was to explore HIV-positive patients' perspectives on living with HIV and diabetes mellitus (DM) or hypertension (HTN) and factors affecting medication adherence. We conducted six focus groups. Two investigators independently coded transcripts for thematic content using editing style analysis. Codes were grouped into conceptual themes using consensus process. Thirty-five HIV-positive patients with diabetes or hypertension participated. Four major themes emerged: (1) Comorbidities are a source of concern and frustration, sometimes eclipsing concern regarding HIV (2) Understanding of health conditions and medications promotes adherence, (3) Simpler regimens with fewer side effects promote adherence, and (4) Untreated substance abuse and mental health issues hinder adherence. HIV-positive patients in this study voiced concern regarding medical comorbidities and highlighted patient understanding, regimen factors, and substance abuse/mental health issues as barriers to adherence. Addressing these issues may improve outcomes in the aging HIV-positive population. Adherence to medications among HIV-positive patients with DM or HTN may be influenced by providing targeted disease-specific education, simplifying regimens, and treatment of substance abuse/mental health issues.
    Full-text · Article · Nov 2013 · BMC Health Services Research
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