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The Effect of
Initiating INSTI-based vs. NNRTI-based
Antiretroviral Therapy on
Progression to Diabetes among
North American Persons in HIV Care
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IDWeek 2019™, October 2-6, 2019, Washington, DC
Reported by Jules Levin
To explore incident diabetes risk by antiretroviral class, the researchers used Cox proportional hazards regression adjusted for age, sex, race/ethnicity, HIV transmission risk, calendar year starting ART, and baseline weight, CD4 count, and viral load.
Diabetes incidence per 1000 person-years measured 9.24 with NNRTIs, 12.03 with INSTIs, and 11.82 with PIs. Adjusted hazard ratios (aHR) indicated about a 25% higher diabetes risk with INSTIs or PIs than with NNRTIs. Adjusted risk stopped short of statistical significant with INSTIs (aHR 1.22, 95% confidence interval [CI] 0.95 to 1.57) but not with PIs (aHR 1.25, 95% CI 1.05 to 1.49).
A separate analysis compared incident diabetes risk with raltegravir, dolutegravir, elvitegravir, or PIs versus NNRTIs. Incidence per 1000 person-years measured 16.22 with raltegravir, 15.57 with dolutegravir, 10.73 with elvitegravir, 13.74 with PIs, and 9.72 with NNRTIs. Starting a PI remained significantly associated with greater diabetes risk than starting with an NNRTI (aHR 1.22). Among individual INSTIs, starting raltegravir was independently associated with greater diabetes risk (aHR 1.50), but starting dolutegravir (aHR 1.14) or elvitegravir (aHR 0.96) was not.
IDWeek 2019: Possible Higher Diabetes Risk With INSTIs or PIs Than NNRTIs - Mark Mascolini (10/4/19)
Peter F. Rebeiro, PhD, MHS
Department of Medicine, Divisions of Infectious Diseases & Epidemiology
Department of Biostatistics
On behalf of Cathy A. Jenkins, MS ♦ Aihua Bian, MS ♦ Jordan E. Lake, MD, MSc ♦ Kassem Bourgi, MD Michael A. Horberg, MD, MAS ♦ Richard D. Moore, MD, MHS ♦ Keri N. Althoff, PhD, MPH ♦ Marina B. Klein, MD, MSc
Joseph Eron, MD ♦ M. John Gill, MB, ChB, MSc ♦ Mari M. Kitahata, MD, MPH ♦ Sonia Napravnik, PhD, MPH Michael J. Silverberg, PhD, MPH ♦ Angel M. Mayor, MD, MSc ♦ Amanda L. Willig, PhD, RD Michelle Floris-Moore, MD, MS ♦ Timothy R. Sterling, MD ♦ John R. Koethe, MD, MSCI for the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD)
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