New-onset diabetes in HIV-treated adults: predictors, long-term renal and cardiovascular outcomes.
AIDS
; 31(11): 1535-1543, 2017 07 17.
Article
in En
| MEDLINE
| ID: mdl-28398958
OBJECTIVE: To determine the incidence and risk factors for developing diabetes mellitus in a cohort of Thai HIV-infected patients on long-term combination antiretroviral therapy (cART). DESIGN: Prospective study conducted between July 1996 and 30 April 2015. METHODS: A total of 1748 patients (60% men) who did not have diabetes mellitus prior to ART were assessed twice a year. Incident diabetes mellitus was defined as either having two consecutive fasting glucose levels more than 126âmg/dl, or reporting antidiabetes mellitus medication/diabetes mellitus diagnosis after starting cART. Incidence rates were calculated per 1000 person-year follow-up. Multivariate Cox regression was used to determine risk factors for the development of diabetes mellitus. RESULTS: During a median follow-up of 9 years (16â274 person-year of follow-up), 123 patients developed new-onset diabetes mellitus, resulting in an incidence rate of 7.6 (95% confidence interval 6.3-9) per 1000 person-year of follow-up. From the multivariate models, age more than 35 years, male sex, BMI at least 25âkg/m, family history of diabetes, abnormal waist circumference, lipodystrophy and exposure to didanosine were significantly associated with incident diabetes mellitus. The diabetes mellitus group had higher mortality rate (8.1 vs. 4.1%, Pâ=â0.04). A significantly higher proportion diabetes vs. nondiabetes patients developed cardiovascular and cerebrovascular complications (8.9 vs. 3.6%, Pâ=â0.008) or chronic kidney disease stage III (estimated glomerular filtration rate <60âml/min/1.73âm) (15.3 vs. 1.9%, Pâ<â0.001) over total follow-up. CONCLUSION: In addition to traditional risk factors, lipodystrophy and use of didanosine were strongly associated with development of incident diabetes. Given the higher rate of cardiovascular-cerebrovascular complications and chronic kidney disease among patients with diabetes mellitus, careful assessment and appropriate management of diabetes mellitus are essential.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Cardiovascular Diseases
/
HIV Infections
/
Didanosine
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Reverse Transcriptase Inhibitors
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HIV-Associated Lipodystrophy Syndrome
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Diabetes Mellitus, Type 2
/
Renal Insufficiency, Chronic
/
Obesity, Abdominal
Type of study:
Etiology_studies
/
Incidence_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Adult
/
Female
/
Humans
/
Male
Country/Region as subject:
Asia
Language:
En
Journal:
AIDS
Journal subject:
SINDROME DA IMUNODEFICIENCIA ADQUIRIDA (AIDS)
Year:
2017
Document type:
Article
Country of publication: