Abstract
Our primary aim was to study diabetes mellitus (DM) arising during combination ART (cART) and to attempt to identify associations between these cases and triglycerides (TRG) and the TRG to HDL-cholesterol (TRG/HDL) ratio. Our secondary aim was to analyse the association between DM development and hepatic fibrosis. This was a retrospective cohort study. Patients from the Icona Foundation study initiating first-line cART between 1997 and 2013 were selected and observed until new-onset DM or most recent clinical follow-up. The predictive value of TRG and TRG/HDL ratio levels on DM was evaluated using multivariable Poisson regression models. Three-thousand, five-hundred and forty-six patients (males, 73.7%; median age, 38 years; median BMI, 23.1 kg/m(2); and hepatitis C virus antibody positive, 22.1%) were included. Of these, 80 developed DM over 13 911 person-years of follow-up (PYFU), corresponding to 5.7 cases per 1000 PYFU (95% CI = 4.6-7.1). At multivariable analysis, latest TRG/HDL ratio, when high, was associated with significant increases in DM risk [relative risk (RR) = 1.63; 95% CI = 1.32-2.01 per 10 points higher], while current TRG, in contrast, was associated with new-onset DM only at crude analysis. Advanced liver fibrosis (defined as fibrosis-4 index >3.25) was also shown to be an independent risk factor for DM (RR = 2.91; 95% CI = 1.10-7.72). High TRG/HDL ratio predicted risk of new-onset DM, independently of other traditional risk factors. Furthermore, our findings suggest that advanced hepatic fibrosis, estimated using the fibrosis-4 score, could provide an additional predictor for DM.
Highlights
Combination ART has dramatically reduced morbidity and mortality in HIV-infected patients, prolonging their life expectancy.[1]
Patients enrolled in the Icona Foundation cohort were included in the present analysis if: (i) they had begun Combination ART (cART) while naive to antiretrovirals, from 1 January 1997 or later; (ii) they had at least one TRG and HDL-c fasting value before baseline, which was defined as cART initiation; (iii) they had a baseline fasting blood glucose ≤126 mg/dL (7 mmol/L); (iv) they were never exposed to antidiabetic or lipid-lowering drugs before baseline; and (v) they had no diagnosis of diabetes mellitus (DM) prior to cART initiation
Incidence rate of DM was calculated as the number of observed cases of DM subsequent to cART initiation divided by person-years of follow-up (PYFU)
Summary
Combination ART (cART) has dramatically reduced morbidity and mortality in HIV-infected patients, prolonging their life expectancy.[1] At the same time, ageing and related comorbidities represent serious challenges in this population. The incidence of comorbidities associated with ageing appears to be much higher and to occur earlier in HIV-infected individuals with respect to their HIV-uninfected counterparts.[2]. Increased risk of diabetes mellitus (DM) in HIV-infected subjects is a matter of debate. Whilst an association between HIV infection and heightened risk of diabetes has been demonstrated in some studies,[3,4,5] other researchers have failed to support such findings.[6,7,8]. Dyslipidaemia is a common feature among HIV-infected patients, during cART.
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call