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Eleven-year incident glucose disorders in treated HIV-infection. The St Vincent’s HIV and Diabetes Study.

Eleven-year incident glucose disorders in treated HIV-infection. The St Vincent’s HIV and Diabetes Study.
Author Information (click to view)

McMahon CN, Petoumenos K, Hesse K, Carr A, Cooper DA, Samaras K,


McMahon CN, Petoumenos K, Hesse K, Carr A, Cooper DA, Samaras K, (click to view)

McMahon CN, Petoumenos K, Hesse K, Carr A, Cooper DA, Samaras K,

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AIDS (London, England) 2017 12 12() doi 10.1097/QAD.0000000000001709

Abstract
OBJECTIVES
To determine the long-term incidence of glucose disorders in treated HIV-infection, associations with traditional and HIV-specific risk factors and whether glycemic status predicts mortality.

METHODS
Observational cohort of 104 men with treated HIV-infection and without diabetes, aged 43 ± 8y at baseline, with (mean ± SD) 11 8 ± 3 5y follow-up, with ascertainment of glucose status by fasting glucose or, in a subset (n = 33), a 75 g oral glucose tolerance test by 10-12 years follow-up. A subset underwent sequential body composition measures (n = 58) to determine changes in total body and central abdominal adiposity.

RESULTS
The cumulative incidence of glucose disorders was 45 8% (pre-diabetes 32 3%, diabetes 12 5%), with an incidence rate of 34 5/1000 years of patient follow-up (PYFU) (pre-diabetes: 24 3/1000 PYFU; diabetes: 10 2/1000 PYFU). Incident glucose disorders were independently associated with higher age (44 9 ± 8 4 vs. 41 1 ± 7 5y, p = 0 027), baseline C-peptide (2 9 ± 1 3 vs. 2 4 ± 1 1ng/mL, p = 0 019) and baseline 2-hour glucose (135 ± 41 vs. 95 ± 25 mg/dL, p < 0 001). A prior AIDS-defining illness was independently associated with higher follow-up fasting glucose (108 ± 38 vs. 94 ± 16 mg/dL, p = 0 007). Abdominal fat gain over 2-4 years was associated with a 3 16-fold increased risk of incident glucose disorders (95%CI 1 30-7 68, p = 0 011). In a subgroup who underwent further oral glucose tolerance testing, 60% had a glucose disorder, the majority not detected by fasting glucose. All-cause mortality not related to baseline glucose status. CONCLUSIONS
Men with long-term treated HIV-infection have high rates of incident glucose disorders associated with modest abdominal fat gain. Directed measures to prevent diabetes in this population are warranted.

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