Treated HIV-infection is associated with insulin resistance (IR), metabolic syndrome and increased risk of diabetes in the short to medium-term. Long-term risk and predictors of glucose disorders are not clear. We hypothesized (i) baseline %body fat, central obesity and IR predicted incident glucose disorders in treated-HIV (ii) baseline glucose predicted mortality.
Methods: Data from a longitudinal cohort study of 144 HIV-infected men attending a tertiary referral hospital and receiving combined anti-retrovirals were analyzed for long-term glucose status, available in 108 (75%). Diabetes and prediabetes (impaired fasting glucose/impaired glucose tolerance) were ascertained by fasting glucose or oral glucose tolerance test.1 All-cause mortality was ascertained from medical records. Longitudinal visceral fat estimates by DEXA were available in a subset at baseline and 12 months.
Results:Mean age at follow-up was 58±8y. Diabetes increased from 2% at baseline to 12% after mean follow-up of 11.1±1.4y. Pre-diabetes increased from 11% to 37%. Incident glucose disorders occurred in 49% (diabetes 11.5%, prediabetes 37.5%). Incident glucose disorders were associated with higher baseline C-peptide (2.9±0.2vs2.2±0.1µg/L p=0.009) but similar baseline age, CD4-count, total and visceral fat, fasting glucose, IR, compared to those with normal glucose levels. In preliminary analyses of the subset with longitudinal DEXA, incident glucose disorders were associated with early gains in visceral fat(p=0.02). Incident diabetes was associated with higher baseline IR (2.8±0.6vs1.7±02, p=0.01), C-peptide (3.4±0.4vs2.2±0.1µg/L, p=0.001) and increased visceral fat at 12 months(p=0.05).
All-cause mortality was 14% over follow-up period. Mortality was 9% in those with incident glucose disorders, 16% in those without (p=0.18). The mortality rate in the general Australian population is 4.62% for men aged 45-64y.2 In logistic regression analysis, no association between mortality and baseline glucose was found, with age, AIDS, CD4-count, BMI or body composition as covariates.
Conclusion:Treated-HIV is associated with high rates of incident glucose disorders at 10-15y, with diabetes predicted by high baseline C-peptide and early visceral fat gain. Measures to prevent diabetes in this high-risk group are warranted