Long-Term HIV Therapy in Men Linked With Abdominal Weight Gain, Incident Glucose Disorder

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Abdominal adiposity, elevated C-peptide, and age were the strongest associations with incident glucose disorders.
Abdominal adiposity, elevated C-peptide, and age were the strongest associations with incident glucose disorders.

Even modest gains in abdominal fat in HIV-positive men undergoing long-term viral treatment are associated with the development of diabetes, according to observational findings published in AIDS.

In this cohort of 104 HIV-positive men without a diabetes diagnosis at baseline, investigators evaluated glucose status via fasting glucose or a 75-gram oral glucose tolerance test at a mean follow-up of 11.8±3.5 years. All patients were undergoing long-term viral treatment for HIV during the study period. A total of 58 patients were evaluated for changes in total body fat and central abdominal adiposity.

At follow-up, the cumulative incidence of disorders in glucose metabolism was 45.8%: 32.3% pre-diabetes and 12.5% incident diabetes. Men who were older (44.9±8.4 vs 41.1±7.5; P =.027) and had higher baseline C-peptide (2.9±1.3 vs 2.4±1.1ng/mL, P =.019) and baseline 2-hour glucose levels (135 ± 41 vs. 95 ± 25 mg/dL, P <.001) were more likely to develop diabetes.

Of the participants who underwent sequential body composition measurements, participants who experienced abdominal fat gain over a 2- to 4-year period had a 3.16-fold increased risk for diabetes (95% CI, 1.30-7.68, P =.011). In addition, participants who had experienced an AIDS-defining illness prior to the study had higher fasting glucose levels at follow-up (108 ± 38 vs 94 ± 16 mg/dL; P =.007).

The small number of participants in this cohort may have underpowered the study's analyses. Also, this study included only Australian men receiving long-term combined antiretroviral therapy, and there is a possibility that these findings cannot be generalized to women or other patients with HIV who have not received adequate treatment.

Overall, the findings suggest the potential for glucose status being an accurate predictor of future diabetes risk and may “identify individuals for early intervention with preventive weight management strategies for cardiometabolic health maintenance and diabetes prevention.”

Reference

McMahon CN, Petoumenos K, Hesse K, et al. Eleven-year incident glucose disorders in treated HIV-infection. The St Vincent's HIV and Diabetes Study [published online December 12, 2017]. AIDS. doi:10.1097/QAD.0000000000001709

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