Protease inhibitor use and the incidence of diabetes mellitus in a large cohort of HIV-infected women.
OBJECTIVE
To assess the association between protease inhibitor (PI) use and the incidence of diabetes mellitus (DM) among participants in the Women's Interagency HIV Study.


METHODS
Prospective multicenter cohort study. The diagnosis of DM was based on self-report at semiannual interviews conducted from 1994 to 1998.


METHODS
Six inner-city clinical sites in the United States (Brooklyn, NY; Bronx, NY; Washington, DC; Chicago, IL; San Francisco, CA; and Los Angeles, CA).


METHODS
A total of 1785 nonpregnant women who had no history of prior DM. The women made up four groups: 1) PI users (n = 609, person-years [PY] at risk = 707); 2) reverse transcriptase inhibitor (RTI)-only users (n = 932, PY = 1486); 3) HIV-infected women reporting no antiretroviral therapy (ART) ever (n = 816, PY = 1480); and 4) HIV-uninfected women (n = 350, PY = 905).


RESULTS
Incidence of DM and median body mass index (BMI) from 1995 to 1998 were compared among the four groups.


RESULTS
Sixty-nine incident cases of DM occurred among 1785 women (1.5 cases per 100 PY; 95% CI: 1.2-1.9). The incidence of DM among PI users was 2.8 cases per 100 PY (2.8%) versus 1.2% among both RTI users and women on no ART (95% CI: 1.6-4.1 [PI]; 0.7-1.8 [RTI and no ART]; P = 0.01 for comparison of the PI group with the RTI group) and 1.4% among HIV-uninfected women (95% CI: 0.7-2.2, P = 0.06 for comparison with PI group). Weight gain was not associated with either PI or RTI use. Multivariate models identified PI use (hazard ratio [HR] = 2.90 [95% CI: 1.50-5.60]; P = 0.002), age (HR = 1.75 per 10 years [95% CI: 1.31-2.34]; P = 0.0002) and BMI as independent risk factors for DM.


CONCLUSIONS
PI use was associated with a threefold increase in the risk of reporting incident DM. Routine screening for diabetes, particularly among older and heavier patients using PI therapy, is advisable.
Justman
Jessica E
JE
Bronx-Lebanon Hospital Center, New York 10457, USA. jjustman@bronxleb.org
Benning
Lorie
L
Danoff
Ann
A
Minkoff
Howard
H
Levine
Alexandra
A
Greenblatt
Ruth M
RM
Weber
Kathleen
K
Piessens
Eva
E
Robison
Esther
E
Anastos
Kathryn
K
D000328:Adult; D015331:Cohort Studies; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000139:chemically induced / Q000453:epidemiology*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007407:Interviews as Topic; D015999:Multivariate Analysis; D011480:Protease Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
D011480:Protease Inhibitors