Question
What is the risk of diabetes from HIV drugs, especially PIs?
13 November 2006. Related: All topics, Side effects.
I have read lots of information on drug side effects, which I find that PIs and some other drugs will highly increase blood sugar and then cause diabetes.
I cannot find the statistics of the rate of the patients who will get diabetes by taking the drugs. So I am wondering, does that everyone take PIs will cause diabetes in the end?
Or only those who have the history of high blood sugar or diabetes are more likely to cause or worse it? or This is just a not common side effect?
Thank you for your time.
Answer
This is an area that is only starting to get more attention in HV research.
Certainly not everyone using PIs with get diabetes, and a very recent study showed that the risk may be linked to other HIV drugs. A history of high blood sugar is likely to increase any risk and highlights the importance of looking at modifiable lifestyle changes.
The MACS cohort in the US suggested that the risk for developing diabetes mellitus (DM) is higher in HIV positive people on treatment than HIV negative people.
This was roughly a 4-fold higher risk: over 4 years new DM occurred in 24 of 229 (10%) HIV positive compared with 10 of 361 (3%) of HIV negative men. Age and Body Mass Index (BMI), which both increase risk of diabetes were both adjusted for in the study. Lipodystrophy is also associated with DM.
However, a much larger analysis from the D:A:D study (that includes over 33,000 patients mainly from European cohorts) reported different results at a conference in Glasgow this week.
The D:A:D study found 2.8% patients had diabetes when they entered the study, and that 745 new cases occurred over 130,000 patient-years of follow up – giving an incidence of 5.7 cases per 1000 patient years,
Interstingly, the only drug significantly linked to the risk of DM was d4T (roughly 8-fold higher risk). Smaller effects were seen for both AZT and ddI. However, both ritonavir and nevirapine showed a slightly reduced (ie beneficial) effect.
However, the study also cautioned that diabetes as serious endpoint, could be missing lower glade changes in reduced glucose tolerance related to PIs (that can be a risk factor for progressing to diabetes in the future).
Many factors associated with higher risk of diabetes and high blood sugar/reduced glucose tolerance, are modifiable. including healthier diet, stopping smoking and increasing exercise. Higher non-modifiable risk factors – a family history of diabetes, male sex, and getting older, makes looking at these other factors is much more important.
Diabetes is a serious illnesses and increases your risk for future heart disease, so reducing risks is good advice.
Comment