Abstract
ObjectiveIn a nationwide, population-based cohort study we assessed the risk of diabetes mellitus (DM) in HIV-infected individuals compared with the general population, and evaluated the impact of risk factors for DM in HIV-infected individuals.MethodsWe identified 4,984 Danish-born HIV-infected individuals from the Danish HIV Cohort Study and a Danish born population-based age- and gender-matched comparison cohort of 19,936 individuals (study period: 1996–2009). Data on DM was obtained from the Danish National Hospital Registry and the Danish National Prescription Registry. Incidence rate ratios (IRR) and impact of risk factors including exposure to Highly Active Antiretroviral Therapy (HAART) and antiretroviral drugs were estimated by Poisson regression analyses.ResultsIn the period 1996–1999 risk of DM was higher in HIV-infected individuals compared to the comparison cohort (adjusted IRR: 2.83; 95%CI: 1.57–5.09), both before (adjusted IRR: 2.40; 95%CI: 1.03–5.62) and after HAART initiation (adjusted IRR: 3.24; 95% CI: 1.42–7.39). In the period 1999–2010 the risk of DM in HIV-infected individuals did not differ from that of the comparison cohort (adjusted IRR: 0.90; 95% CI: 0.72–1.13), although the risk was decreased before HAART-initiation (adjusted IRR: 0.45; 95%CI: 0.21–0.96). Increasing age, BMI and the presence of lipoatrophy increased the risk of DM, as did exposure to indinavir, saquinavir, stavudine and didanosine.ConclusionNative HIV–infected individuals do not have an increased risk of developing DM compared to a native background population after year 1998. Some antiretroviral drugs, not used in modern antiretroviral treatment, seem to increase the risk of DM.
Highlights
Since the late nineties, studies on HIV-infected individuals have reported a wide spectrum of metabolic alterations associated with Highly Active Antiretroviral therapy (HAART) including changes in glucose homeostasis and fat redistribution [1,2,3]
To evaluate the impact of certain risk factors we further examined the influence of age, body mass index (BMI), lipoatrophy, HAART and specific antiretroviral drugs on risk of diabetes mellitus (DM) in HIV-infected individuals
In Danish born HIV-infected individuals risk of DM did not differ from that of a Danish born comparison cohort
Summary
Studies on HIV-infected individuals have reported a wide spectrum of metabolic alterations associated with Highly Active Antiretroviral therapy (HAART) including changes in glucose homeostasis and fat redistribution [1,2,3]. As the lifespan of HIV-infected individuals have been prolonged, due to a decline in HIV-associated morbidity and mortality on account of HAART [4,5], such metabolic imbalances could affect the long-tem prognosis due to progression of insulin resistance to diabetes mellitus (DM) and subsequent risk of end-organ disease. Since the US Food and Drug Administration in 1997 issued a warning on the diabetogenic effects of protease inhibitors (PIs), risk of glucose alterations in HIV-infected individuals have been largely attributed to this drug class [14,15,16,17,18]. Several studies have addressed the risk of DM in the HIV-infected population [7,9,10,11,18,19,21,22,23,24], but the results are conflicting and the majority of the studies are hampered by mixed ethnicity and lack of a comparison cohort from the general population
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