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Incident diabetes in course of antiretroviral therapy
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Taramasso, Luciaa; Squillace, Nicolab; Ricci, Elenac; Menzaghi, Barbarad; Orofino, Giancarloe; Socio, Giuseppe Vittorio Def; Molteni, Chiarag; Martinelli, Canio Vitoh; Madeddu, Giordanoi; Vichi, Francescaj; Valsecchi, Laurak; Celesia, Benedetto Mauriziol; Maggi, Paolom; Rusconi, Stefanon; Pellicanò, Giovanni Francescoo; Cascio, Antoniop; Sarchi, Eleonoraq; Gulminetti, Robertor; Falasca, Katias; Di Biagio, Antonioa,t; Bonfanti, Paolob
The preliminary results of the present study have been previously presented as Oral Presentation (OC ID#42) at the14 th Italian Conference on AIDS and Antiviral Research, 2022.
Do I think big gains in weight over time translate to potential for increased diabetes? yes. Jules
Risk factors for progression from prediabetes to diabetes in persons with HIV - Integrase Inhibitors Tied to Lower Risk of Progression from Prediabetes to Diabetes - HAILO raltegravir had no impact on development of new diabetes in the big US insurance database study [2].
INCIDENT DIABETES ASSOCIATED WITH INTEGRASE STRAND TRANSFER INHIBITOR INITIATION
No association was observed in those on raltegravir-based therapy (HR 1.04 [95% CI 0.92, 1.17]).
Abstract
"Of note, in our study, the mean weight gain was moderate, 0.7 and 1.3 Kg at 1- and 2-years, probably explaining why weight gain did not associate with increased risk of DM, contrary to expectations [4,7,35,41]."
Objective:
Recent reports of excessive weight gain in people living with HIV (PWH) have raised increasing concerns on the possible increase of diabetes mellitus (DM) risk in course of integrase inhibitor (INSTIs) treatment. In this study, we aimed at describing DM incidence in course of antiretroviral therapy (ART) and identifying the factors associated with new DM onset.
Design:
Observational prospective SCOLTA (Surveillance Cohort Long-Term Toxicity Antiretrovirals) cohort.
Methods:
All people enrolled in SCOLTA between January 2003 and November 2021 were included. Multivariable Cox regression yielded adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for incident DM.
Results:
4,366 PWH were included, 72.6% male, with mean age 45.6 years, and median CD4 460 (IQR 256-710) cells/mm3cells/mm3. During the follow up, 120 incident cases of DM occurred (1.26 cases/100 person year-follow up, 95% CI 1.05-1.50).
Baseline weight, but not the amount of weight gain, resulted significantly correlated to diabetes incidence (aHR by 1 Kg 1.03; 95%CI 1.01-1.04), as well as older age (aHR 1.03 by 1 year; 95%CI 1.01-1.06), being ART-experienced with detectable HIV RNA at study entry (aHR 2.27, 95%CI 1.48-3.49), having untreated high blood pressure (aHR 2.90; 95%CI 1.30-6.45) and baseline blood glucose >100 mg/dL (aHR 5.47; 95%CI 3.82-7.85).
Neither the INSTI class nor individual antiretrovirals were associated with an increased risk of DM.
Conclusions:
baseline weight, but not weight gain or the ART class, was associated with incident DM in this observational cohort.
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