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Session 90 Poster Session Incidence, Prevalence, and Pathogenic Correlates of Insulin Resistance and Lipodystrophy Syndrome Session Time: 4:30-6:30 pm Room 4E-F

678-T. Case-Control Study of Diabetes Mellitus in HIV-Infected Patients C. Yoon*1, R. Gulick1, D. Hoover2, C. Vaamonde1, and M. Glesby1 1Weill Med. Coll. of Cornell Univ., New York, NY and 2Rutgers Univ., Piscataway, NJ Background: Although glucose abnormalities have been associated with use of protease inhibitors (Pis), other factors may contribute to the development of diabetes mellitus (DM) in HIV-infected patients. To delineate risk factors for DM, we conducted a case-control study in an urban HIV clinic. Methods: Incident diagnoses of DM among patients in active follow-up were identified (cases) excluding DM induced by medications other than Pis. 2 controls per case were matched on age +/- 5 years, race, gender, and length of clinic follow-up. HIV risk factors, family history of DM, hepatitis B (HBV) and C (HCV) infection, antiretroviral use, body mass index (BMI), lipodystrophy (physician diagnosis), CD4 cell counts (nadir and at time of DM diagnosis), HIV viral load (PCR), mean serum alanine aminotransferase levels (ALT), and mean cholesterol were evaluated at or prior to onset of diabetes in cases or the equivalent period of follow-up in controls. Conditional logistic regression was used to identify factors associated with DM. Results: From May 1991 to December 2000, we identified 50 cases of DM. 1 case was excluded as no matched controls could be found, leaving 49 cases and 98 controls. Mean time from initial visit to DM diagnosis was 27 months, mean age was 45 years, 65% were male, 39% African American, 34% Hispanic, and 27% Caucasian. Compared with controls, cases had a higher mean BMI (30.0 vs 25.3 kg/m2; matched odds ratio [OR] 1.20; p < 0.001), higher mean ALT (66.3 vs 43.7 U/L; OR 1.01; p= 0.013), stronger family history of DM (50% vs 29.1%; OR 3.30; p= 0.009), and higher prevalence of fat accumulation (29.6% vs 12.8%; OR 3.40; p= 0.025). HCV coinfection was more common in cases than controls (51.1% vs 36.5%; OR 2.10; p= 0.066), and cases had greater prior/current PI use (71.4% vs 58.2%; OR 2.30; p= 0.072). In multivariate analyses, only BMI (OR 1.18 /kg/m2; p= 0.010), family history (OR 9.41; p= 0.034), and ALT (OR 1.02 /U/L; p= 0.047) were associated with DM. Conclusions: Although PI use and HCV co-infection may contribute to risk of DM, as shown by others, traditional risk factors (i.e. obesity, family history) account for much of the risk of DM in HIV-infected persons. The association of serum ALT level with DM may reflect liver injury or steatosis, which may predispose to hyperglycemia. These findings suggest that there are complex interrelationships between genetic factors, treatment-induced metabolic changes, and liver injury in the pathogenesis of DM in HIV-infected patients.

©2002 9th Conference on Retroviruses and Opportunistic Infections