title: Diabetes Mellitus is Associated with Increased Death Rates Among HIV-Infected Patients in Rio de Janeiro, Brazil.
abstract: Diabetes mellitus (DM) is a major cause of morbidity worldwide and a known factor leading to increased risk of death, especially in conjunction with other risk factors. In this study, we evaluated the prevalence of DM among HIV-infected patients and its association with overall mortality. All HIV-infected patients 18 years or older who were followed in the Instituto Nacional de Infectologia Evandro Chagas (INI) cohort from January 1991 to December 2011 were included. Time-updated covariables included DM status, calendar year, combination antiretroviral therapy (cART), and CD4 cell counts. Fixed demographic covariables included gender and age at entry. Poisson models were used to calculate mortality rate ratios (RR) with robust variances. Among the 4,871 patients included, 1,192 (24.4%) died (mortality rate = 4.72/100 person-years [PY]; 95% confidence interval [CI] = 4.46-5.00). Death rates were significantly higher among those presenting with DM compared with those who did not (6.16/100 vs. 4.61/100 PY, respectively. p = 0.001). In the final model, DM was significantly associated with mortality (RR = 1.74; 95% CI = 1.57-1.94; p < 0.001). When the analysis was restricted to those on cART or the period post-1996, the association between DM and mortality was even stronger (RR = 2.17; 95% CI = 1.91-2.46; p < 0.001 and RR = 1.95; 95% CI = 1.75-2.18; p < 0.001, respectively). Among the major groups of cause of deaths (CODs), the proportion of AIDS-related conditions in patients with DM was lower (74.27% vs. 58.93%, respectively; p < 0.001); whereas in non-AIDS-related conditions, nonimmunodeficiency-related causes (22.44% vs. 34.82%, respectively; p = 0.004) were more common in patients with DM. In conclusion, DM was associated with increased mortality rates even after controlling for HIV-related variables associated to this outcome. Differences in the underlying CODs were identified, reinforcing the necessity to assess and treat comorbidities such as DM in HIV-infected patients.
authors.affiliation: 1 Programa de Computação Científica, FIOCRUZ , Rio de Janeiro, Brazil .|2 Instituto Nacional de Infectologia Evandro Chagas, FIOCRUZ , Rio de Janeiro, Brazil .
authors.forename: Rodrigo C
authors.initials: RC
authors.lastname: Moreira
authors.affiliation: 1 Programa de Computação Científica, FIOCRUZ , Rio de Janeiro, Brazil .
authors.forename: Antonio G
authors.initials: AG
authors.lastname: Pacheco
authors.affiliation: 1 Programa de Computação Científica, FIOCRUZ , Rio de Janeiro, Brazil .
authors.forename: Adelzon
authors.initials: A
authors.lastname: Paula
authors.affiliation: 2 Instituto Nacional de Infectologia Evandro Chagas, FIOCRUZ , Rio de Janeiro, Brazil .
authors.forename: Sandra W
authors.initials: SW
authors.lastname: Cardoso
authors.affiliation: 2 Instituto Nacional de Infectologia Evandro Chagas, FIOCRUZ , Rio de Janeiro, Brazil .
authors.forename: Ronaldo I
authors.initials: RI
authors.lastname: Moreira
authors.affiliation: 2 Instituto Nacional de Infectologia Evandro Chagas, FIOCRUZ , Rio de Janeiro, Brazil .
authors.forename: Sayonara R
authors.initials: SR
authors.lastname: Ribeiro
authors.affiliation: 2 Instituto Nacional de Infectologia Evandro Chagas, FIOCRUZ , Rio de Janeiro, Brazil .
authors.forename: Estevão P
authors.initials: EP
authors.lastname: Nunes
authors.affiliation: 2 Instituto Nacional de Infectologia Evandro Chagas, FIOCRUZ , Rio de Janeiro, Brazil .
authors.forename: Maria R
authors.initials: MR
authors.lastname: Guimarães
authors.affiliation: 3 Instituto de Doenças do Tórax, Universidade Federal do Rio de Janeiro , Rio de Janeiro, Brazil .
authors.forename: Fernanda C
authors.initials: FC
authors.lastname: Mello
authors.affiliation: 2 Instituto Nacional de Infectologia Evandro Chagas, FIOCRUZ , Rio de Janeiro, Brazil .
authors.forename: Valdilea G
authors.initials: VG
authors.lastname: Veloso
authors.affiliation: 2 Instituto Nacional de Infectologia Evandro Chagas, FIOCRUZ , Rio de Janeiro, Brazil .
authors.forename: Beatriz
authors.initials: B
authors.lastname: Grinsztejn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D048909:Diabetes Complications; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000401:mortality*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009026:Mortality; D055815:Young Adult
keywords: death rates; diabetes mellitus; people living with HIV