Case-Control Study of Diabetes Mellitus in HIV-Infected Patients
Case-Control Study of Diabetes Mellitus in HIV-Infected Patients
Background: Diabetes mellitus (DM) is more prevalent among patients with HIV infection. Besides protease inhibitors (PIs), other factors may contribute to the development of DM.
Objective: To assess characteristics associated with the development of DM in HIV-infected persons.
Methods: We conducted a case-control study in an urban HIV clinic among patients with incident DM (49 cases) matched to 2 controls (n = 98) on age ±5 years, race, sex, and length of clinic follow-up. There was a second set of unmatched controls (n = 196).
Results: Compared with matched controls, case patients had higher mean body mass index (BMI; 30.0 vs. 25.3 kg/m, matched odds ratio [OR] = 1.20; P < 0.001), higher alanine aminotransferase (ALT; 66 vs. 44 U/L, OR = 1.12 per 10 U/L; P = 0.013), and stronger family history of DM (50% vs. 29%, OR = 3.30; P = 0.009). Hepatitic C virus coinfection and PI use were not significant factors. In unmatched controls, there was no significant difference in age, sex, or ethnicity. In multivariate analyses, BMI (OR = 1.13 per kg/m; P = 0.012), family history (OR = 5.55; P = 0.014), and ALT (OR = 1.16; P = 0.012) were associated with DM.
Conclusion: These findings suggest a complex interaction among genetic factors, body composition, and liver injury in the pathogenesis of DM in HIV-infected patients.
Disorders of glucose metabolism have been reported in individuals infected with HIV. Cross-sectional studies have reported a prevalence of diabetes of 2% to 7% among HIV-infected patients receiving protease inhibitors (PIs) and an additional 16% having impaired glucose tolerance. The incidence of diabetes mellitus (DM) in HIV-infected patients has been estimated to range from 1% to 10% in various studies. An analysis of a California Medicaid database found that the age-specific relative risk for diabetes in persons with HIV compared with those without was indeed higher in all age groups, peaking at 7.74 among those 18 to 24 years of age.
Clinical and in vitro data support a direct causative role of certain PIs in the pathogenesis of insulin resistance and DM in some patients with HIV infection. Other data have linked insulin resistance and diabetes to the lipodystrophy syndrome that is prevalent in HIV-infected patients and whose pathogenesis remains poorly understood. The relation of risk factors for DM that are well established in the general population such as family history, obesity, race/ethnicity, age, and dyslipidemia is poorly understood in HIV-infected patients, however. Furthermore, few data exist on the potential relations between DM and liver disease in HIV-infected patients, which may be of importance given emerging data associating DM with hepatitis C virus (HCV) infection in the general population. Drugs such as megestrol acetate and corticosteroids seem to be responsible for severe hyperglycemia in HIV-infected persons. To identify potential risk factors for diabetes in HIV-infected persons, we performed a retrospective case-control study of patients attending an urban HIV clinic.
Background: Diabetes mellitus (DM) is more prevalent among patients with HIV infection. Besides protease inhibitors (PIs), other factors may contribute to the development of DM.
Objective: To assess characteristics associated with the development of DM in HIV-infected persons.
Methods: We conducted a case-control study in an urban HIV clinic among patients with incident DM (49 cases) matched to 2 controls (n = 98) on age ±5 years, race, sex, and length of clinic follow-up. There was a second set of unmatched controls (n = 196).
Results: Compared with matched controls, case patients had higher mean body mass index (BMI; 30.0 vs. 25.3 kg/m, matched odds ratio [OR] = 1.20; P < 0.001), higher alanine aminotransferase (ALT; 66 vs. 44 U/L, OR = 1.12 per 10 U/L; P = 0.013), and stronger family history of DM (50% vs. 29%, OR = 3.30; P = 0.009). Hepatitic C virus coinfection and PI use were not significant factors. In unmatched controls, there was no significant difference in age, sex, or ethnicity. In multivariate analyses, BMI (OR = 1.13 per kg/m; P = 0.012), family history (OR = 5.55; P = 0.014), and ALT (OR = 1.16; P = 0.012) were associated with DM.
Conclusion: These findings suggest a complex interaction among genetic factors, body composition, and liver injury in the pathogenesis of DM in HIV-infected patients.
Disorders of glucose metabolism have been reported in individuals infected with HIV. Cross-sectional studies have reported a prevalence of diabetes of 2% to 7% among HIV-infected patients receiving protease inhibitors (PIs) and an additional 16% having impaired glucose tolerance. The incidence of diabetes mellitus (DM) in HIV-infected patients has been estimated to range from 1% to 10% in various studies. An analysis of a California Medicaid database found that the age-specific relative risk for diabetes in persons with HIV compared with those without was indeed higher in all age groups, peaking at 7.74 among those 18 to 24 years of age.
Clinical and in vitro data support a direct causative role of certain PIs in the pathogenesis of insulin resistance and DM in some patients with HIV infection. Other data have linked insulin resistance and diabetes to the lipodystrophy syndrome that is prevalent in HIV-infected patients and whose pathogenesis remains poorly understood. The relation of risk factors for DM that are well established in the general population such as family history, obesity, race/ethnicity, age, and dyslipidemia is poorly understood in HIV-infected patients, however. Furthermore, few data exist on the potential relations between DM and liver disease in HIV-infected patients, which may be of importance given emerging data associating DM with hepatitis C virus (HCV) infection in the general population. Drugs such as megestrol acetate and corticosteroids seem to be responsible for severe hyperglycemia in HIV-infected persons. To identify potential risk factors for diabetes in HIV-infected persons, we performed a retrospective case-control study of patients attending an urban HIV clinic.
