HIV-positive adults who initiated older formulations of antiretroviral therapy are more likely to develop type 2 diabetes than patients who initiated therapy between 2010 and 2015, according to study findings reported in BMJ Open Diabetes Research & Care.
“Combination antiretroviral therapy (ART) has dramatically increased the life expectancy of people living with HIV; however, they are now developing comorbidities associated with prolonged survival and aging, and these may be occurring at earlier ages than in the general population,” Faizal Samad, clinical trials coordinator with the AIDS Research Program at St. Paul’s Hospital in Vancouver, British Columbia, Canada, and colleagues wrote in the study background. “Many [people living with HIV], particularly those who received older antiretroviral treatments, experienced peripheral fat atrophy, visceral fat accumulation and metabolic comorbidities, including dyslipidemia and impaired glucose homeostasis, which can lead to increased risk for cardiovascular disease and other related morbidities.”
Samad and colleagues analyzed data from 1,065 patients with HIV aged at least 50 years who initiated ART before July 2015 and did not have diabetes at baseline. All participants were treated at a large urban HIV outpatient clinic at St. Paul’s Hospital through July 2015. Researchers identified diabetes incidence through database records and chart review. The rate of new-onset diabetes was defined as the number of cases of diabetes divided by the total number of person-years of follow-up. A final, multivariable analysis used data from 703 participants — excluding patients who started ART before 1997 and did not have plasma HIV viral load results in the period before initiating therapy.
During a median of 13 years, researchers observed 235 new diabetes diagnoses among the entire cohort, for an incidence rate of 1.61 cases per 100 person-years.
Of the 703 patients included in multivariable analyses (89% men; 73% white), 132 developed diabetes. Among those with diabetes, 43% had hepatitis C virus coinfection, 8% had hepatitis B virus coinfection and 38% had a history of injection drug use. The median HbA1c was 5.8% for the 36% of patients with diabetes who had HbA1c results available, according to researchers.
Patients who initiated ART between 1997 and 2004 were more likely to develop diabetes vs. those who initiated ART between 2010 and 2015 (30% vs. 2%; P < .001), with an adjusted OR of 48.9 (95% CI, 21.32-112.17). Increased length of time on ART also increased the odds of developing type 2 diabetes (aOR = 0.69; 95% CI, 0.64-0.74).
The patients who developed type 2 diabetes tended to be younger at the end of the study, had a viral load of at least 500 copies/mL for a greater proportion of follow-up time and had a lower CD4 count at end of follow-up compared with those who did not develop type 2 diabetes; however, these associations did not rise to significance in adjusted models, according to researchers.
“Longer exposure to ART agents and the use of older drugs were associated with a higher incidence of [diabetes] in our study,” the researchers wrote. “On the other hand, obesity, HCV coinfection, and older age were not associated with the incidence of [diabetes] in this cohort. The incidence of [diabetes] is likely to decline in [people living with HIV] who initiated ART more recently with the use of newer ART agents.” – by Regina Schaffer