Protease inhibitors and diabetes

NAM Publications HIV & AIDS Information :: Diabetes

Diabetes is considered a relatively rare side effect of protease inhibitors. One study reported 1.4% developed high blood glucose at one year. Another study reported a 4% rate of diabetes and an 8% rate of glucose intolerance. The French APROCO cohort found that 10% of patients developed diabetes over three years of PI therapy, with incidence steady over time. 1

A review of the WIHS cohort of 1785 women recruited in the US between 1994 and 1998 found that women receiving PI-containing HAART had an elevated risk of diabetes (2.8 cases per 100 patient years of treatment, compared to 1.4 in the HIV-negative group, 1.2 on NRTIs only and 1.2 on no HIV therapy). 2

However, recent research has identified combination antiretroviral therapy (HAART), coinfection with hepatitis C, baseline obesity or elevated blood sugar, and HIV infection itself as risk factors for hyperglycaemia and diabetes. Data from the Multi-center AIDS Cohort Study (MACS) show that PIs, d4T and efavirenz are all associated with the development of diabetes and hyperglycaemia in HIV-infected people on treatment. Compared to HIV-negative men, HIV-positive men not taking HAART were twice as likely to have diabetes, and HIV-positive men on HAART were five times more likely. Between 1999 and 2003, nearly 20% of the HIV-positive men on HAART developed hyperglycaemia and 11% developed diabetes. 3 4

Other studies have also found diabetes more commonly among individuals with HIV. 5 However, others suggest that traditional risk factors for diabetes account for much of the risk in HIV-positive patients. 6 7 8 On balance, the role of HIV as a risk factor for diabetes remains unproven.

References
1. Saves M et al. Incidence of lipodystrophy and glucose and lipid abnormalities during the followup of a cohort of HIV-infected patients started on a protease inhibitor (PI)containing regimen. Ninth Conference on Retroviruses and Opportunistic Infections, Seattle, abstract 682, 2002
2. Justman JE et al. Protease inhibitor use and the incidence of diabetes mellitus in a large cohort of HIV-infected women. AIDS 32: 298302, 2003
3. Brown T et al. Prevalence and incidence of pre diabetes and diabetes in the Multi-center AIDS Cohort Study. Eleventh Conference on Retroviruses and Opportunistic Infections, San Francisco, abstract 73, 2004
4. Brown TT et al. Antiretroviral therapy and the prevalence and incidence of diabetes mellitus in the Multicenter AIDS Cohort Study. Arch Intern Med 165: 11791184, 2005
5. Currier JS et al. Diabetes mellitus in HIV-infected individuals. Ninth Conference on Retroviruses and Opportunistic Infections, Seattle, abstract 677, 2002
6. Rosario P et al. Factors associated with the development of diabetes mellitus in HIV-infected patients on antiretroviral therapy: a case controlled study. AIDS 17: 933 935, 2003
7. Yoon C et al. Case control study of diabetes mellitus in HIV-infected patients. JAIDS 37 (4); 14641469, 2004
8. Danoff A et al. Oral glucose tolerance and insulin sensitivity are unaffected by HIV infection or antiretroviral therapy in overweight women. J Acquir Immune Defic Syndr 39: 5562, 2005

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