Disorders of glucose metabolism among HIV-infected women.
BACKGROUND
Abnormal glucose metabolism in HIV-infected patients has largely been attributed to the use of protease inhibitors. However, most studies of glucose metabolism in HIV-infected patients have focused on men or have lacked appropriate control groups.


METHODS
We assessed the factors associated with previously diagnosed diabetes among 620 middle-aged women with or at risk for HIV infection. For a subset of 221 women without previously diagnosed diabetes, we performed an oral glucose tolerance test (OGTT) to measure glucose and insulin levels, and we assessed factors associated with abnormal glucose tolerance, insulin resistance, and insulin secretion.


RESULTS
Thirteen percent of the women in the present study had previously diagnosed diabetes. Among women without previously diagnosed diabetes who underwent an OGTT, 6% had previously undiagnosed diabetes, and 12% had impaired glucose tolerance (IGT). According to multivariate analysis, factors that were associated with previously diagnosed diabetes included current methadone treatment, body mass index of > or =25, family history of diabetes, and physical inactivity. Factors that were independently associated with an abnormal result of an OGTT (i.e., a result consistent with IGT or diabetes) included age > or =50 years, family history of diabetes, physical inactivity, and a high number of pack-years of smoking. Factors independently associated with insulin resistance included waist circumference, Hispanic ethnicity, physical inactivity, and, among HIV-infected women, use of HAART that did not include protease inhibitors. Factors associated with lower levels of insulin secretion included current opiate use (i.e., methadone or heroin) and older age.


CONCLUSIONS
Abnormal glucose metabolism is highly prevalent among middle-aged women with or at risk for HIV infection, particularly women who use opiates. Screening for diabetes in the HIV primary care setting should occur for women who have classic risk factors for diabetes, rather than solely for women who are taking PIs. Interventions that target modifiable risk factors, including obesity and physical inactivity, are also warranted.
Howard
Andrea A
AA
Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York, USA. ahoward@montefiore.org
Floris-Moore
Michelle
M
Arnsten
Julia H
JH
Santoro
Nanette
N
Fleischer
Norman
N
Lo
Yungtai
Y
Schoenbaum
Ellie E
EE
D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000378:metabolism*; D005260:Female; D005947:Glucose / Q000378:metabolism*; D005951:Glucose Tolerance Test; D015658:HIV Infections / Q000150:complications* / Q000378:metabolism*; D006801:Humans; D007328:Insulin / Q000097:blood / Q000378:metabolism; D007333:Insulin Resistance; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors
D007328:Insulin; D005947:Glucose