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Protease Inhibitor Use and the Incidence of Diabetes Mellitus in a Large
Cohort of HIV-Infected Women
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OBJECTIVE To assess the association between protease inhibitor (PI) use and
the incidence of diabetes mellitus (DM) among participants in the Women's
Interagency HIV Study.
DESIGN Prospective multicenter cohort study. The diagnosis of DM was based on
self-report at semiannual interviews conducted from 1994 to 1998.SETTING Six
inner-city clinical sites in the United States (Brooklyn, NY; Bronx, NY;
Washington, DC; Chicago, IL; San Francisco, CA; and Los Angeles,
CA).PARTICIPANTS A total of 1785 nonpregnant women who had no history of
prior DM. The women made up four groups: 1) PI users (n = 609, person-years
[PY] at risk = 707); 2) reverse transcriptase inhibitor (RTI)-only users (n =
932, PY = 1486); 3) HIV-infected women reporting no antiretroviral therapy
(ART) ever (n = 816, PY = 1480); and 4) HIV-uninfected women (n = 350, PY =
905).
MAIN OUTCOMES Incidence of DM and median body mass index (BMI) from 1995 to
1998 were compared among the four groups.
RESULTS Sixty-nine incident cases of DM occurred among 1785 women (1.5 cases
per 100 PY; 95% CI: 1.2-1.9). The incidence of DM among PI users was 2.8
cases per 100 PY (2.8%) versus 1.2% among both RTI users and women on no ART
(95% CI: 1.6-4.1 [PI]; 0.7-1.8 [RTI and no ART]; = 0.01 for comparison of the
PI group with the RTI group) and 1.4% among HIV-uninfected women (95% CI:
0.7-2.2, = 0.06 for comparison with PI group). Weight gain was not associated
with either PI or RTI use. Multivariate models identified PI use (hazard
ratio [HR] = 2.90 [95% CI: 1.50-5.60]; = 0.002), age (HR = 1.75 per 10 years
[95% CI: 1.31-2.34]; = 0.0002) and BMI as independent risk factors for DM.
CONCLUSIONS PI use was associated with a threefold increase in the risk of
reporting incident DM. Routine screening for diabetes, particularly among
older and heavier patients using PI therapy, is advisable.
J Acquir Immune Defic Syndr 2003 Mar 1;32(3):298-302.
Justman JE, Benning L, Danoff A, Minkoff H, Levine A, Greenblatt RM, Weber K,
Piessens E, Robison E, Anastos K.
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