Diabetes rates predicted to rise with HIV treatment

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Takeaway

  • Glycemia should be monitored in antiretroviral (ART) -treated patients and diabetes prevention efforts encouraged.  

Why this matters

  • WHO recommends ART for HIV-infected patients regardless of CD4-count and age.
  • Noninfectious comorbidities may diminish ART’s overall health benefits.

Study design

  • Meta-analysis of 43 studies published during 2000-2017 from all WHO regions.
  • Funding: None.

Key results

  • Pooled diabetes incidence among ART-treated adults with baseline normoglycemia was 13.7 per 1000 person-years (95% CI, 11.4-20), and cumulative incidence rate was 4.9% (4.0-5.9).
  • The probability of developing diabetes was 13.7% after 3.7 years of follow-up.
  • Incidence and cumulative incidence rates for prediabetes were 125/1000 person-years (95% CI, 0-423) and 14.9% (9.1-21.8), respectively.
  • Major risk factors for progression to prediabetes/diabetes were older age, diabetes family history, Black or Hispanic origin, overweight/obesity, central obesity, lipodystrophy/lipoatrophy, dyslipidemia, metabolic syndrome, and increased baseline fasting glycemia.
  • ART regimens associated with increased risk were protease inhibitors (indinavir, ritonavir, atazanavir), zidovudine, didanosine, lamivudine, efavirenz, stavudine, and nevirapine, although not all were linked to dysglycemia in all studies.

Limitations

  • Substantial heterogeneity in incidence estimates.
  • Newer ART drugs have less metabolic effect, but this may be counterbalanced by increasing widespread initiation of ART.
  • Reporting discrepancies across studies.
  • Only studies published in English or French included.