title: Incidence of Diabetes Mellitus and Obesity and the Overlap of Comorbidities in HIV+ Hispanics Initiating Antiretroviral Therapy.
abstract: BACKGROUND
  Cardiovascular disease (CVD) is a leading health threat for HIV+ patients on antiretroviral therapy (ART); cardiometabolic comorbidities are key predictors of risk. Data are limited on incidence of metabolic comorbidities in HIV+ individuals initiating ART in low and middle income countries (LMICs), particularly for Hispanics. We examined incidence of diabetes and obesity in a prospective cohort of those initiating ART in the Dominican Republic.
  
  
  METHODS
  Participants ≥18 years, initiating ART <90 days prior to study enrollment, were examined for incidence of impaired fasting glucose (IFG), diabetes mellitus (DM), overweight, and obesity. Fasting plasma glucose (FPG) 100-125mg/dl defined IFG; FPG ≥126 mg/dl, diagnosis per medical record, or use of hypoglycemic medication defined DM. Overweight and obesity were BMI 25-30 and ≥30kg/m2, respectively. Dyslipidemia was total cholesterol ≥240mg/dl or use of lipid-lowering medication. Framingham risk equation was used to determine ten-year CVD risk at the end of observation.
  
  
  RESULTS
  Of 153 initiating ART, 8 (6%) had DM and 23 (16%) had IFG at baseline, 6 developed DM (28/1000 person-years follow up [PYFU]) and 46 developed IFG (329/1000 PYFU). At baseline, 24 (18%) were obese and 36 (27%) were overweight, 15 became obese (69/1000 PYFU) and 22 became overweight (163/1000 PYFU). Median observation periods for the diabetes and obesity analyses were 23.5 months and 24.3 months, respectively. Increased CVD risk (≥10% 10-year Framingham risk score) was present for 13% of the cohort; 79% of the cohort had ≥1 cardiometabolic comorbidity, 48% had ≥2, and 13% had all three.
  
  
  CONCLUSIONS
  In this Hispanic cohort in an LMIC, incidences of IFG/DM and overweight/obesity were similar to or higher than that found in high income countries, and cardiometabolic disorders affected three-quarters of those initiating ART. Care models incorporating cardiovascular risk reduction into HIV treatment programs are needed to prevent CVD-associated mortality in this vulnerable population.
authors: Department of Medicine, Columbia University Medical Center, New York, New York, United States of America.
authors: Angelina
authors: A
authors: Gomes
authors: Unidad de Tratamiento de ITS y VIH, Instituto Dermatológico y Cirugía de Piel "Dr. Humberto Bogaert Diaz", Santo Domingo, Dominican Republic.
authors: Emily V
authors: EV
authors: Reyes
authors: University of Texas Health Science Center San Antonio, San Antonio, Texas, United States of America.
authors: L Sergio
authors: LS
authors: Garduno
authors: Unidad de Tratamiento de ITS y VIH, Instituto Dermatológico y Cirugía de Piel "Dr. Humberto Bogaert Diaz", Santo Domingo, Dominican Republic.
authors: Rita
authors: R
authors: Rojas
authors: Departamento de Medicina, Profamilia, Santo Domingo, Dominican Republic.
authors: Geraldine
authors: G
authors: Mir Mesejo
authors: Departamento de Medicina, Profamilia, Santo Domingo, Dominican Republic.
authors: Eliza
authors: E
authors: Del Rosario
authors: Unidad de Tratamiento de ITS y VIH, Instituto Dermatológico y Cirugía de Piel "Dr. Humberto Bogaert Diaz", Santo Domingo, Dominican Republic.
authors: Lina
authors: L
authors: Jose
authors: Unidad de Tratamiento de ITS y VIH, Instituto Dermatológico y Cirugía de Piel "Dr. Humberto Bogaert Diaz", Santo Domingo, Dominican Republic.
authors: Carmen
authors: C
authors: Javier
authors: Department of Medicine, Columbia University Medical Center, New York, New York, United States of America.
authors: Catherine
authors: C
authors: Vaughan
authors: Unidad de Vacunas, Instituto Dermatológico y Cirugía de Piel "Dr. Humberto Bogaert Diaz", Santo Domingo, Dominican Republic.
authors: Yeycy
authors: Y
authors: Donastorg
authors: Department of Medicine, Columbia University Medical Center, New York, New York, United States of America.
authors: Scott
authors: S
authors: Hammer
authors: Department of Medicine, Columbia University Medical Center, New York, New York, United States of America.
authors: Karen
authors: K
authors: Brudney
authors: Department of Medicine, Columbia University Medical Center, New York, New York, United States of America.|University of Texas Health Science Center San Antonio, San Antonio, Texas, United States of America.
authors: Barbara S
authors: BS
authors: Taylor
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D015331:Cohort Studies; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000821:virology; D004293:Dominican Republic / Q000453:epidemiology; D005260:Female; D018149:Glucose Intolerance; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology*; D006630:Hispanic or Latino; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology* / Q000821:virology; D050177:Overweight / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents