New-onset diabetes in HIV-treated adults: predictors, long-term renal and cardiovascular outcomes

AIDS. 2017 Jul 17;31(11):1535-1543. doi: 10.1097/QAD.0000000000001496.

Abstract

Objective: To determine the incidence and risk factors for developing diabetes mellitus in a cohort of Thai HIV-infected patients on long-term combination antiretroviral therapy (cART).

Design: Prospective study conducted between July 1996 and 30 April 2015.

Methods: A total of 1748 patients (60% men) who did not have diabetes mellitus prior to ART were assessed twice a year. Incident diabetes mellitus was defined as either having two consecutive fasting glucose levels more than 126 mg/dl, or reporting antidiabetes mellitus medication/diabetes mellitus diagnosis after starting cART. Incidence rates were calculated per 1000 person-year follow-up. Multivariate Cox regression was used to determine risk factors for the development of diabetes mellitus.

Results: During a median follow-up of 9 years (16 274 person-year of follow-up), 123 patients developed new-onset diabetes mellitus, resulting in an incidence rate of 7.6 (95% confidence interval 6.3-9) per 1000 person-year of follow-up. From the multivariate models, age more than 35 years, male sex, BMI at least 25 kg/m, family history of diabetes, abnormal waist circumference, lipodystrophy and exposure to didanosine were significantly associated with incident diabetes mellitus. The diabetes mellitus group had higher mortality rate (8.1 vs. 4.1%, P = 0.04). A significantly higher proportion diabetes vs. nondiabetes patients developed cardiovascular and cerebrovascular complications (8.9 vs. 3.6%, P = 0.008) or chronic kidney disease stage III (estimated glomerular filtration rate <60 ml/min/1.73 m) (15.3 vs. 1.9%, P < 0.001) over total follow-up.

Conclusion: In addition to traditional risk factors, lipodystrophy and use of didanosine were strongly associated with development of incident diabetes. Given the higher rate of cardiovascular-cerebrovascular complications and chronic kidney disease among patients with diabetes mellitus, careful assessment and appropriate management of diabetes mellitus are essential.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Antiretroviral Therapy, Highly Active
  • Asian Continental Ancestry Group
  • Body Mass Index
  • Cardiovascular Diseases / etiology
  • Cardiovascular Diseases / prevention & control*
  • Cohort Studies
  • Diabetes Mellitus, Type 2 / complications
  • Diabetes Mellitus, Type 2 / physiopathology*
  • Didanosine / administration & dosage
  • Didanosine / adverse effects*
  • Female
  • HIV Infections / complications
  • HIV Infections / physiopathology*
  • HIV-Associated Lipodystrophy Syndrome / complications*
  • HIV-Associated Lipodystrophy Syndrome / physiopathology
  • Humans
  • Incidence
  • Male
  • Obesity, Abdominal / complications*
  • Obesity, Abdominal / physiopathology
  • Proportional Hazards Models
  • Renal Insufficiency, Chronic / etiology
  • Renal Insufficiency, Chronic / prevention & control*
  • Reverse Transcriptase Inhibitors / administration & dosage
  • Reverse Transcriptase Inhibitors / adverse effects*
  • Risk Factors
  • Thailand
  • Treatment Outcome

Substances

  • Reverse Transcriptase Inhibitors
  • Didanosine