title: Incidence of diabetes mellitus in a population-based cohort of HIV-infected and non-HIV-infected persons: the impact of clinical and therapeutic factors over time.
abstract: OBJECTIVE
  To examine incidence density rate and correlates of incident diabetes mellitus in a cohort of HIV-infected individuals compared with matched non-HIV-infected persons.
  
  
  METHODS
  Data were obtained from the South Carolina Medicaid system and the enhanced HIV/AIDS Reporting System surveillance database for persons ≥ 18 years of age who had been attended to during the period 1994 to 2011. Time-dependent proportional hazards analysis and marginal structural models were used to analyse the data.
  
  
  RESULTS
  A total of 13 632 individuals (6816, 1:1 matched HIV-infected and non-HIV-infected persons; median age 39 years; 57% male) contributed 88 359 person-years of follow-up. Incidence rate of diabetes was higher in the non-HIV-infected group compared with the HIV-infected group (13.60 vs. 11.35 per 1000 person-years). Multivariable hazards analysis suggested a significantly lower risk of incident diabetes among HIV-infected persons treated with combination antiretroviral therapy compared with the matched non-HIV-infected persons (adjusted hazards ratio 0.55; 95% CI 0.46-0.65). Among HIV-infected persons, marginal structural modelling suggested a significantly higher risk of diabetes with cumulative exposure to protease inhibitors over the observation period (adjusted relative risk 1.35; 95% CI 1.03-1.78), but this association was not significant for exposure to non-nucleoside reverse transcriptase inhibitors. Overall, female gender, older age, non-white race/ethnicity, and pre-existing hypertension, dyslipidaemia, obesity and hepatitis C infection were associated with higher risk of diabetes incidence.
  
  
  CONCLUSIONS
  HIV infection may not be independently associated with increased risk of diabetes. Among HIV-infected persons, exposure to protease inhibitor-based regimens may increase the risk of diabetes. Healthcare providers should make every effort to use combination antiretroviral therapy regimens with a better cardiometabolic profile.
authors.affiliation: Division of Internal Medicine, Department of Medicine, University of Mississippi School of Medicine, Jackson, MS, USA.
authors.forename: A
authors.initials: A
authors.lastname: Tripathi
authors.forename: A D
authors.initials: AD
authors.lastname: Liese
authors.forename: J M
authors.initials: JM
authors.lastname: Jerrell
authors.forename: J
authors.initials: J
authors.lastname: Zhang
authors.forename: A A
authors.initials: AA
authors.lastname: Rizvi
authors.forename: H
authors.initials: H
authors.lastname: Albrecht
authors.forename: W A
authors.initials: WA
authors.lastname: Duffus
mesh_terms: D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000139:chemically induced / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology; D003924:Diabetes Mellitus, Type 2 / Q000139:chemically induced / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology; D004359:Drug Therapy, Combination / Q000009:adverse effects; D062665:Epidemiological Monitoring; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D017320:HIV Protease Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008484:Medicaid; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013022:South Carolina / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D017320:HIV Protease Inhibitors