Publications

Abstract

OBJECTIVES: To determine the long-term incidence of glucose disorders in treated HIV-infection, associations with traditional and HIV-specific risk factors and whether glycemic status predicts mortality. METHODS: Observational cohort of 104 men with treated HIV-infection and without diabetes, aged 43 +/- 8y at baseline, with (mean +/- SD) 11 8 +/- 3 5y follow-up, with ascertainment of glucose status by fasting glucose or, in a subset (n = 33), a 75 g oral glucose tolerance test by 10-12 years follow-up. A subset underwent sequential body composition measures (n = 58) to determine changes in total body and central abdominal adiposity. RESULTS: The cumulative incidence of glucose disorders was 45 8% (pre-diabetes 32 3%, diabetes 12 5%), with an incidence rate of 34 5/1000 years of patient follow-up (PYFU) (pre-diabetes: 24 3/1000 PYFU; diabetes: 10 2/1000 PYFU). Incident glucose disorders were independently associated with higher age (44 9 +/- 8 4 vs. 41 1 +/- 7 5y, p = 0 027), baseline C-peptide (2 9 +/- 1 3 vs. 2 4 +/- 1 1ng/mL, p = 0 019) and baseline 2-hour glucose (135 +/- 41 vs. 95 +/- 25 mg/dL, p < 0 001). A prior AIDS-defining illness was independently associated with higher follow-up fasting glucose (108 +/- 38 vs. 94 +/- 16 mg/dL, p = 0 007). Abdominal fat gain over 2-4 years was associated with a 3 16-fold increased risk of incident glucose disorders (95%CI 1 30-7 68, p = 0 011). In a subgroup who underwent further oral glucose tolerance testing, 60% had a glucose disorder, the majority not detected by fasting glucose. All-cause mortality not related to baseline glucose status. CONCLUSIONS: Men with long-term treated HIV-infection have high rates of incident glucose disorders associated with modest abdominal fat gain. Directed measures to prevent diabetes in this population are warranted.