title: Associations of statins and antiretroviral drugs with the onset of type 2 diabetes among HIV-1-infected patients.
abstract: Statin use is associated with a modest increase in the incidence of type 2 diabetes mellitus (DM) among the general population. However, HIV-infected patients have a higher risk of developing DM, and it is unclear whether statins have a diabetogenic effect in these patients. Therefore, we investigated the associations of statin use and exposure to antiretroviral drugs with type 2 DM onset in a cohort of HIV-infected patients.
  
  
  
  This retrospective, controlled, cohort study identified HIV-1-infected patients who did not have DM and were not receiving statins at their antiretroviral treatment (ART) initiation. Follow-up was accrued from ART initiation to the earliest instance of a DM diagnosis, loss to follow-up, death, or last available visit. The incidence of DM was estimated according to statin use, which was adjusted for periods without statin treatment. The Fine-Gray competing risk model was used in the multivariate analysis to identify risk factors for developing DM.
  
  
  
  The analyses evaluated 6,195 patients followed for 9.8 years (interquartile range: 4.3-16.3 years). During 64,149 person-years of follow-up (PYFU), 235 patients developed DM (crude incidence: 3.66 [95%CI: 3.20-4.13] per 1,000 PYFU), and 917 (14%) patients used statins. After adjusting for potential confounders, statin use was associated with a non-significant increase in the risk of DM (AHR: 1.21, 95% CI: 0.71-2.07; P = 0.47). DM was more likely among patients who were ever treated with stavudine, and less likely among those ever treated using emtricitabine, tenofovir, abacavir, efavirenz, nevirapine, atazanavir or darunavir.
  
  
  
  A higher risk of diabetes mellitus was not associated with statin treatment but with traditional risk factors and stavudine use while a reduced risk of DM was associated with the use of emtricitabine, tenofovir, abacavir, efavirenz, nevirapine, atazanavir or darunavir.
authors.affiliation: Department of Infectious Diseases, San Raffaele Scientific Institute, via Stamira d'Ancona 20, 20127, Milan, Italy. spagnuolo.vincenzo@hsr.it.|Università Vita-Salute San Raffaele, Milan, Italy. spagnuolo.vincenzo@hsr.it.
authors.forename: Vincenzo
authors.identifier: 0000-0002-9656-7217
authors.initials: V
authors.lastname: Spagnuolo
authors.affiliation: Department of Infectious Diseases, San Raffaele Scientific Institute, via Stamira d'Ancona 20, 20127, Milan, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Galli
authors.affiliation: Università Vita-Salute San Raffaele, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Poli
authors.affiliation: Department of Infectious Diseases, San Raffaele Scientific Institute, via Stamira d'Ancona 20, 20127, Milan, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Salpietro
authors.affiliation: Department of Infectious Diseases, San Raffaele Scientific Institute, via Stamira d'Ancona 20, 20127, Milan, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Gianotti
authors.affiliation: Cardiometabolic and Clinical Trials Unit, Internal Medicine Department, Metabolic and Cardiovascular Division, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Piermarco
authors.initials: P
authors.lastname: Piatti
authors.affiliation: Department of Infectious Diseases, San Raffaele Scientific Institute, via Stamira d'Ancona 20, 20127, Milan, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Cossarini
authors.affiliation: Department of Infectious Diseases, San Raffaele Scientific Institute, via Stamira d'Ancona 20, 20127, Milan, Italy.
authors.forename: Concetta
authors.initials: C
authors.lastname: Vinci
authors.affiliation: Department of Infectious Diseases, San Raffaele Scientific Institute, via Stamira d'Ancona 20, 20127, Milan, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Carini
authors.affiliation: Department of Infectious Diseases, San Raffaele Scientific Institute, via Stamira d'Ancona 20, 20127, Milan, Italy.|Università Vita-Salute San Raffaele, Milan, Italy.
authors.forename: Adriano
authors.initials: A
authors.lastname: Lazzarin
authors.affiliation: Department of Infectious Diseases, San Raffaele Scientific Institute, via Stamira d'Ancona 20, 20127, Milan, Italy.|Università Vita-Salute San Raffaele, Milan, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Castagna
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control / Q000821:virology; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy; D015497:HIV-1 / Q000472:pathogenicity; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D019380:Anti-HIV Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Antiretrovirals drugs; Cohort study; Diabetes; HIV; Risk factors; Statins