title: Ten-year diabetes incidence in 1046 HIV-infected patients started on a combination antiretroviral treatment.
abstract: OBJECTIVE
  To evaluate the incidence and determinants of diabetes in a cohort of HIV-infected adults initiated with combination antiretroviral treatment (cART) in 1997-1999 and followed up to 2009.
  
  
  METHODS
  Prospective study of 1046 patients at 47 French clinical sites.
  
  
  METHODS
  Potential determinants of diabetes occurrence, defined by confirmed increased glycemia and/or initiation of antidiabetic treatment, were assessed by a proportional hazards model, including time-updated metabolic parameters and ART exposure.
  
  
  RESULTS
  Among the cohort, representing 7846 person-years of follow-up (PYFU), 54% received indinavir, 75% stavudine and 52% didanosine. Overall, 111 patients developed diabetes, with an incidence of 14.1/1000 PYFU (14.6 in men, 12.6 in women). Incidence peaked in 1999-2000 (23.2/1000 PYFU) and decreased thereafter. The incidence of diabetes was associated [adjusted hazard ratio (aHR), all P<0.02] with older age (hazard ratio = 2.13 when 40-49 years, hazard ratio = 3.63 when ≥50 years), overweight (hazard ratio = 1.91 for a BMI 25-29 kg/m(2), hazard ratio = 2.85 >30 kg/m(2)), waist-to-hip ratio (hazard ratio = 3.87 for ≥0.97 male/0.92 female), time-updated lipoatrophy (hazard ratio = 2.14) and short-term exposure to indinavir (0-1 year: hazard ratio = 2.53), stavudine (0-1 year: hazard ratio = 2.56, 1-2 years: hazard ratio = 2.65) or didanosine (2-3 years: hazard ratio = 3.16). Occurrence of diabetes was not associated with HIV-related markers, hepatitis C, hypertension or family history of diabetes. Insulin resistance was predictive for incident diabetes.
  
  
  CONCLUSIONS
  In this nationwide cohort, followed for 10 years after cART initiation, diabetes incidence peaked in 1990-2000, was markedly higher than that reported for European uninfected or other HIV-infected populations (4-6/1000 PYFU) and linked with age and adiposity. Adiposity and glycemic markers should be monitored in aging HIV-infected patients.
authors.affiliation: UPMC Univ Paris, UMR_S, Inserm, CDR Saint-Antoine, AP-HP, Hôpital Tenon, France. Jacqueline.capeau@inserm.fr
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Capeau
authors.forename: Vincent
authors.initials: V
authors.lastname: Bouteloup
authors.forename: Christine
authors.initials: C
authors.lastname: Katlama
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Bastard
authors.forename: Vincent
authors.initials: V
authors.lastname: Guiyedi
authors.forename: Dominique
authors.initials: D
authors.lastname: Salmon-Ceron
authors.forename: Camelia
authors.initials: C
authors.lastname: Protopopescu
authors.forename: Catherine
authors.initials: C
authors.lastname: Leport
authors.forename: Francois
authors.initials: F
authors.lastname: Raffi
authors.forename: Geneviève
authors.initials: G
authors.lastname: Chêne
mesh_terms: D050154:Adiposity; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D023241:Antiretroviral Therapy, Highly Active; D015992:Body Mass Index; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000139:chemically induced / Q000188:drug therapy / Q000453:epidemiology*; D016049:Didanosine / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D019469:Indinavir / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D018119:Stavudine / Q000008:administration & dosage / Q000009:adverse effects; D049629:Waist-Hip Ratio
chemical_list: D019380:Anti-HIV Agents; D019469:Indinavir; D018119:Stavudine; D016049:Didanosine