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Abstract
Objective We sought to determine the incidence and factors associated with development of diabetes mellitus (DM) in older HIV-infected individuals.
Research design and methods We analyzed data from people living with HIV (PLWH) ≥50 years of age enrolled in a large urban HIV outpatient clinic in Vancouver, British Columbia. Patients were categorized as having DM if they had random blood sugar ≥11.1 mmol/L, fasting blood sugar ≥7 mmol/L, HbA1C ≥6.5%, antidiabetic medication use during the follow-up period, or medical chart review confirming diagnosis of DM. We estimated the probability of developing DM, adjusting for demographic and clinical factors, using a logistic regression model.
Results Among 1065 PLWH followed for a median of 13 years (25th and 75th percentile (Q1–Q3): 9-18), the incidence of DM was 1.61/100 person-years follow-up. In the analysis of factors associated with new-onset DM (n=703), 88% were male, 38% had a history of injection drug use, 43% were hepatitis C coinfected, and median body mass index was 24 kg/m2 (Q1–Q3: 21–27). Median age at antiretroviral therapy (ART) initiation was 48 years (Q1–Q3: 43–53) and at DM diagnosis was 55 years (Q1–Q3: 50–61). Patients who started ART in 1997–1999 and had a longer exposure to older ART were at the highest risk of developing DM.
Conclusions Among PLWH aged ≥50 years, the incidence of DM was 1.39 times higher than men in the general Canadian population of similar age. ART initiated in the early years of the epidemic and exposure to older ART appeared to be the main drivers of the development of DM.
- hiv
- adult diabetes
- incidence
- aging
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Footnotes
Contributors Study conception and design: FS, MH, CMP, VDL and SAG. Data acquisition: SC. Data analysis: MY, JC and VDL. Data interpretation: FS, MH, CMP, MY, GPB, VDL, JSGM and SAG. Manuscript draft: FS. Critical revision for important intellectual content: FS, MH, CMP, MY, JC, SC, GPB, VDL, JSGM and SAG. Approval of final version and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: all authors.
Competing interests JSGM has received funding for clinical trials that have been paid to the institution from: the BC Ministry of Health for the STOP HIV/AIDS Initiative, NIDA-NIH (R01DA036307) for STOP HIV/AIDS in IDUs, McGill University for CTN 222 and Gladstone Institute of Virology-UCSF for Diflunisal in HIV. JSGM also reports grants from Janssen, Merck, Abbvie, Bristol-Myers Squibb, Gilead Sciences, ViiV Healthcare, outside the submitted work; he has served on the advisory boards for Teva, Gilead Sciences, and InnaVirVax. SAG reports personal fees from Gilead Sciences and ViiV Healthcare, outside the submitted work. MH reports participation in clinical trials with AbbVie, Amgen Canada and Gilead Sciences Canada, and received grants and personal fees from Gilead Sciences Canada, Merck Canada,and ViiV Healthcare, outside the submitted work. CMP reports grants from ViiV Healthcare Canada, outside the submitted work. GPB reports personal fees from Lily, Boehringer Ingelheim, Merck, AstraZeneca, Novo Nordisk, Janssen, Amgen, and Sanofi, outside the submitted work.
Ethics approval University of British Columbia/Providence Health Care Research Ethics Board (H05-50123).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement All data are housed at the British Columbia Centre for Excellence in HIV/AIDS Drug Treatment Program. Requests for data access may be made to the British Columbia Centre for Excellence in HIV/AIDS Data Committee under the Director of Operations, Irene Day, iday@cfenet.ubc.ca.