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