October 27, 2008
There's nothing like hearing the results of studies directly from those who actually conducted the research. In this interview, you'll meet one of these impressive HIV researchers and read his explanation of the study he presented at ICAAC/IDSA 2008.
I am Adeel Butt with the University of Pittsburgh Medical Center and VA Pittsburgh Healthcare System.
We looked at the risk of diabetes mellitus in HIV-infected and uninfected people.1 The study was conducted in the Veterans Aging Cohort Study, which is an ongoing, live cohort of more than 3,500 HIV-positive, and more than 3,500 HIV-uninfected, controls. What we found was that the actual prevalence of diabetes in the HIV-positive people is lower, than when compared to the HIV-negative group.
Adeel A. Butt, M.D.
I think the biggest drivers of these lower rates in prevalence and risk are the traditional risk factors. For example, the mean BMI [body mass index] in the HIV-positive group was about 25. In the HIV-negative group, the mean BMI was about 28.9. This is a 4-point difference, and I think that is driving that significantly.
The other thing is, if you look at the use of antiretroviral therapy within the HIV-positive group, antiretroviral therapy is associated with a slightly higher risk for diabetes, but that risk is kind of totally mitigated by other traditional risk factors.
Could you talk a little bit about the characteristics of the patients?
This is a veterans cohort, so the patients are all veterans and about 97% of them are men. The mean age at entry in the HIV-positive group was 49.6 years and in the HIV-negative group it was 50.8 years. About 10% to 15% of them are over 60 years old, so we have a fair representation across the age groups. It's a very racially diverse cohort, with a large number of minorities included in both the HIV-positive and HIV-negative groups because of a control for that.
The HCV [hepatitis C virus] coinfection rate was about 31% in the HIV-positive group and about 15% in the HIV-negative group. The mean BMI, as I already pointed out, is about 25.2 in the HIV-positive group and 28.9 in the HIV-negative group.
What was the relationship of drug and alcohol use to diabetes risk?
Those are not very significant. We used AUDIT-C to look at the hazards of alcohol use. It seems that there may be some protective risk overall, but it's not very clear how alcohol plays into the whole equation. But with illicit drug use, we did not find any significant association in the HIV-positive group. In the HIV-negative group there was a slight protective effect of illicit drug use. I think the odds ratio was about .67 in the HIV-negative group, and that was significant.
What's the take-home?
The take-home is that the big driver of diabetes in the HIV-positive group is still the traditional risk factors, not HIV itself. HIV itself is a relatively minor contributor at this point in time. As these people gain weight, when they go on antiretroviral therapy and are well-suppressed, their risk of diabetes might increase after that.
Thank you very much.
This transcript has been lightly edited for clarity.