Antiretroviral therapy exposure and incidence of diabetes mellitus in the Womens Interagency HIV Study
Polly Clayden, HIV i-Base
A paper in the August 20 2007 edition of AIDS authored by Phyllis Tien and coworkers looked at the incidence of diabetes mellitus (DM) in the Womens Interagency HIV Study (WIHS). WIHS is an American, nationally representative cohort of HIV-positive women and a comparison group of HIV-negative women.
This was a prospective study between October 2000 and March 2006 of 2088 participants from the WIHS who did not have evidence of DM at enrollment (1524 HIV-positive and 564 HIV-negative).
The study defined Incident DM as either having fasting glucose >/=1.26 g/l, reporting antidiabetic medication, or reporting DM diagnosis (with subsequent confirmation by fasting glucose >/=1.26 g/l or reported antidiabetic medication). All were assessed at twice yearly study visits.
116 HIV-positive women and 36 HIV-negative women developed DM in over 6802 person-years. HIV-positive women reporting no recent antiretroviral therapy (n=25) had a DM incidence rate of 1.53/100 person-years; those reporting HAART containing a PI (n=41) had a rate of 2.50/100 person-years. Those reporting non-PI containing (n=41) HAART a rate of 2.89/100 person-years. HIV-negative women had a DM incidence rate of 1.96/100 person-years.
For HIV-positive women, longer cumulative exposure to NRTI was associated with an increased risk of DM incidence compared with no NRTI exposure: relative hazard (RH) 1.81 [95% confidence interval (CI), 0.833.93] for >0 to 3 years exposure and RH 2.64 (95% CI, 1.116.32) for >3 years exposure. In this study neither cumulative exposure to an NNRTI nor a PI was associated with DM incidence.
The investigators looked at the rate of DM among HIV-positive women receiving the four most frequently used NRTIs (AZT, abacavir, d4T and 3TC). They found cumulative exposure of >1 year to 3TC was associated with a three fold increase in DM after adjustment.
They concluded: NRTI are in the backbone of effective ART, and so regular monitoring of fasting glucose levels in HIVinfected patients is warranted. Study of the biological mechanisms by which NRTI might induce disorders in glucose metabolism is a priority.
Tiena PC, Schneiderb MF, Stephen R. Coleb SR et al. Antiretroviral therapy exposure and incidence of diabetes mellitus in the Womens Interagency HIV Study. AIDS, 2007, 21:17391745.