Antiretroviral therapy exposure and incidence of diabetes mellitus in the Women's Interagency HIV Study

Objective: To determine the incidence of diabetes mellitus (DM) in a nationally representative cohort of HIV-infected women and a comparison group of HIV-uninfected women. Design: A prospective study between October 2000 and March 2006 of 2088 participants from the Women's Interagency HIV Study who did not have evidence of DM at enrollment (1524 HIV infected and 564 HIV uninfected). Methods: Incident DM was defined as either having fasting glucose >= 1.26 g/l, reporting anticliabetic medication, or reporting DM diagnosis (with subsequent confirmation by fasting glucose >= 1.26g/l or reported anticliabetic medication); all were assessed at semi-annual study visits. Results: DM developed in 116 HIV-infected and 36 HIV-uninfected women over 6802 person-years. HIV-infected women reporting no recent antiretroviral therapy had a DM incidence rate of 1.53/100 person-years; those reporting HAART containing a protease inhibitor (PI) had a rate of 2.50/100 person-years and those reporting non-PI-containing HAART a rate of 2.89/100 person-years. None of these rates differed from the HIV-uninfected women (1.96/100 person-years) substantially or beyond levels expected by chance. Among HIV-infected women, longer cumulative exposure to nucleoside reverse transcriptase inhibitors (NRTI) was associated with an increased risk of DM incidence compared with no NRTI exposure: relative hazard (RH) 1.81 [95% confidence interval (CI), 0.83-3.93] for > 0 to 3 years exposure and RH 2.64 (95% Cl, 1.11-6.32) for > 3 years exposure. Conclusion: Longer cumulative exposure to NRTI was associated with increased DM incidence in HIV-infected women. Regular DM monitoring is advisable because NRTI form the backbone of effective antiretroviral therapy.