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Antiretroviral Therapy and the Prevalence and Incidence of Diabetes Mellitus in the Multicenter AIDS Cohort Study
Todd T. Brown, MD;
Stephen R. Cole, PhD;
Xiuhong Li, MAS;
Lawrence A. Kingsley, DrPH;
Frank J. Palella, MD;
Sharon A. Riddler, MD, MPH;
Barbara R. Visscher, MD, DrPH;
Joseph B. Margolick, MD, PhD;
Adrian S. Dobs, MD, MHS
Arch Intern Med. 2005;165:1179-1184.
Background The risk of diabetes mellitus (DM) in human immunodeficiency virus (HIV)–infected patients receiving highly active antiretroviral therapy (HAART) has not been well defined.
Methods 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.
Results 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.
Conclusion 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.
Author Affiliations: Department of Medicine, School of Medicine (Drs Brown and Dobs) and Department of Epidemiology, Bloomberg School of Public Health (Drs Cole and Margolick and Ms Li), The Johns Hopkins University, Baltimore, Md; Department of Epidemiology, School of Public Health (Dr Kingsley) and Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pa (Dr Riddler); Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ill (Dr Palella); and the Department of Epidemiology, School of Public Health, University of California–Los Angeles (Dr Visscher).
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