Risk Factors

Abnormal glucose homeostasis and insulin resistance

The American Diabetes Association recommends that impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) should not be viewed as clinical entities in their own right, but as risk factors for diabetes and cardiovascular disease.1 This risk is continuous according to the degree of impairment, being disproportionately greater at higher ends of the range.

Risk factors in people living with HIV

Known risk factors for diabetes and insulin resistance in people living with HIV include:

  • the use of some protease inhibitors (PIs) (indinavir and lopinavir/ritonavir)2,3 and nucleoside reverse transcriptase inhibitors (NRTIs) (didanosine, stavudine and zidovudine)3,4
  • NRTIs that induce lipoatrophy, particularly stavudine and didanosine in combination, also induce insulin resistance5
  • dorsocervical fat accumulation (buffalo hump) and lipodystrophy6–8

Other known risk factors in people living with HIV include:8

  • use of some neuroleptic drugs9 and some antihypertensives10
  • family history of diabetes
  • weight gain
  • co-infection with hepatitis C virus
     

References

  1. American Diabetes Association. Standards of Medical Care in Diabetes 2011. Diabetes Care. 2011;34;Suppl 1:S11–S61.
  2. Noor MA, Seneviratne T, Aweeka FT, et al. Indinavir acutely inhibits insulin-stimulated glucose disposal in humans: a randomized, placebo-controlled study. AIDS. 2002;16:F1–8.
  3. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents. Department of Health and Human Services, 2011. Accessed 18 March 2011.
  4. De Wit S, Sabin CA, Weber R, et al. Incidence and risk factors for new-onset diabetes in HIV-infected patients: the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study. Diabetes Care. 2008;31:1224–1229.
  5. Shlay JC, Visnegarwala F, Bartsch G, et al. Body composition and metabolic changes in antiretroviral-naive patients randomized to didanosine and stavudine vs. abacavir and lamivudine. J Acquir Immune Defic Syndr. 2005;38:147–155.
  6. Hadigan C, Meigs JB, Corcoran C, et al. Metabolic abnormalities and cardiovascular disease risk factors in adults with human immunodeficiency virus infection and lipodystrophy. Clin Infect Dis. 2001;32:130–139.
  7. Mallon PW, Wand H, Law M, et al. Buffalo hump seen in HIV-associated lipodystrophy is associated with hyperinsulinemia but not dyslipidemia. J Acquir Immune Defic Syndr. 2005;38:156–162.
  8. Mullen MP and Caplivski D. HIV and comorbidities: A Case Based Approach to Diagnosis and Management. Oxford American Infectious Disease Library. Oxford University Press. 2008.
  9. Sernyak MJ, Leslie DL, Alarcon RD, et al. Association of diabetes mellitus with use of atypical neuroleptics in the treatment of schizophrenia. Am J Psychiatry. 2002;159(4):561-566.
  10. Elliott WJ, Mayer PM. Incident diabetes in clinical trials of antihypertensive drugs: a network meta-analysis. Lancet. 2007;20;369(9557):201-207.