Work

Diabetes, Mortality, and the Burden of Comorbidities in People Living With HIV (PLHIV), and the Effect of Exposure to Protease Inhibitors: A Single-Center Study in the Midwestern United States

Year: 2016

Type: article

Abstract: Background. Patients with both HIV and diabetes might be at greater risk of metabolic and other adverse outcomes. We planned to evaluate the prevalence of various comorbidities and mortality in PLHIV with and without diabetes and to evaluate the association between exposure to different classes of antiretrovirals and risk of diabetes. Methods. We conducted a retrospective cross-sectional period prevalence study using the HERON research data repository at Kansas University Medical Center (KUMC), and we enrolled all adults with an ICD-9 diagnosis of HIV from 2000 to 2015. Demographics, comorbidities, and medication prescription data were abstracted from the database. The association between exposure to different classes of antiretrovirals and diagnosis of diabetes was evaluated by multivariate logistic regression. The association between time to diabetes diagnosis and time to death was evaluated using multivariate Cox regression. Results. Of 1816 adults with HIV seen at KUMC from 200 to2015, 80.9% were male, 56.9% were white, 9.0% were Hispanic, and 59.8% were prescribed antiretrovirals. At HIV code entry, mean age was 47.5 years and mean body mass index was 26.7 kg/m2. The period prevalence of diabetes was 14.7% (267/1816). This prevalence increased with increasing age at HIV code entry (up to 30.4% in those >65 years). PLHIV and diabetes were more likely than those without diabetes to have neuropathy (18.4% versus 1.7%), hypertension (76.8% versus 25.1%), chronic kidney disease (32.6% versus 8.2%), ischemic heart disease (28.1% versus 7.6%), hypothyroidism (17.2% versus 4.6%), cerebrovascular disease (24% versus 7.2%), hypercholesterolemia (23.2% versus 7.0%), vitamin D deficiency (32.2% versus 10.8%), hyperglyceridemia (14.2% versus 6.5%), hepatitis C (16.9% versus 7.8%), depression (45.3% versus 27.2%), and chronic obstructive pulmonary disease (38.2% versus 22.1%). Exposure to protease inhibitors was associated with a 2.9 times increased risk of diabetes (95% confidence interval 1.3–2.7) compared with exposure to other antiretroviral classes and a 2.5 times increased risk compared with treatment-naïve patients. Diabetes was associated with 2.37 times higher hazard of death (95% confidence interval 1.55–3.63). Conclusion. Over a 15 year period, the prevalence of diabetes in this cohort of PLHIV seen at KUMC is significantly higher than that reported in the literature, and it is associated with increased morbidity and mortality. More awareness is needed among physicians. Disclosures. All authors: No reported disclosures.

Source: Open Forum Infectious Diseases

DOI: 10.1093/ofid/ofw172.1689

Authors: Shubhanker Mitra, Wissam El Atrouni, Busuyi Olotu, Rafia Rasu, Lemuel R Waitman

Institutions: Christian Medical College, Vellore, University of Kansas Medical Center, University of Kansas

Language: English