7th Conference on Retroviruses and Opportunistic Infections San Francisco, CA - January 30 -February 4, 2000

Conf Retroviruses Opportunistic Infect 2000 Jan 30-Feb 2; 7:78 (abstract no. 16)

E. Martinez, M. A. Garcia, I. Conget, E. Buira, J. L. Blanco, J. Mallolas, J. M. Miro, R. Casamitjana, And J. M. Gatell
Hospital Clinic University, Barcelona, Spain.

OBJECTIVES: To describe the incidence, characteristics, and prognosis of diabetes mellitus (DM) in HIV-1 infected patients treated with protease inhibitors (PI).

METHODS: Patients with normal glucose at baseline who started PI from 6/96 to 6/99 and had at least 6 months of PI therapy were included. Clinical visits and fasting blood analysis were performed at baseline and every 3 months.

RESULTS: Out of 782 patients included, 126 (16%) developed impaired fasting glucose and 19 (2.4%) developed DM. Patients with DM were mainly men (n=16, 84%) and their median age was 40 years. The incidence of DM remained stable (1.2 cases per 100 patients exposed per year). DM was diagnosed a median of 10 months after starting PI therapy. Only 6 (32%) patients had symptoms due to hyperglycemia at diagnosis of DM. Median values of glucose, triglycerides (T), cholesterol (C) (mg/dL), and HbAlc (%) were 160, 293, 164, and 6.2, respectively. T, C, and HbAlc were higher than normal in 14, 7, and 4 patients. Beta cell autoantibodies were negative and beta cell function was preserved. Six men and 1 woman showed increased WHR but only 1 person was obese (BMI >27kg/m²). Ten patients (53%) were treated with diet alone, 4 (21%) we provided with metformin, and 5 (26%) required insulin (all 5 with ketoacidosis). K_ITT was normal in 2 patients with ketoacidosis. PI were withdrawn only in 3 patients (all of them with ketoacidosis). Insulin could be withdrawn after a median of 6 months. No complications due to DM have occurred so far. Twelve patients (63%) developed lipodystrophy (all with central obesity, and 4 with fat wasting too) after a median of 6 months from DM diagnosis.

CONCLUSIONS: The risk of developing DM in HIV-1 patients treated with PI was higher than in the general population, but it did not increase over time. Concurrent hyperlipidemia was common and the risk of subsequent lipodystrophy was high. Beta cell function was preserved and surprisingly we did not find evidence of insulin resistance. Need for insulin therapy decreased over time.

2000-01-30
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