The Effects of Protease Inhibitors on Metabolic Complications and Lipodystrophy in Human Immunodeficiency Virus-Infected Patients

Abstract

Problem statement: Highly Active Antiretroviral Therapy (HAART)-associated metabolic complications include lipoatrophy (loss of Subcutaneous Adipose Tissue (SAT) and insulin resistance. The risk of Diabetes Mellitus (DM) in Human Immunodeficiency Virus (HIV)-infected patients receiving Highly Active Antiretroviral Therapy (HAART) especially protease inhibitors has not been well defined. Approach: We conducted an analysis in the Hospital of Rajeev Gandhi Institute of Medical Sciences (RIMS), Adilabad district of Andhra Pradesh to determine the prevalence and incidence of DM in the cohort of HIV-infected and HIV seronegative men. Prevalence analysis included 1278 men (710 HIV seronegative and 568 HIV infected, 411 receiving protease inhibitors) with fasting glucose concentration determinations at baseline. Results: Fifty-seven (14%) of the 411 HIV-infected men using protease inhibitors at the baseline visit had prevalent DM compared with 33 (5%) of the 711 HIV-seronegative men (prevalence ratio = 4.6; adjusted for age and body mass index). The rate of incident DM was 4.7 cases per 100 person-years among HIV-infected men using protease inhibitors compared with 1.4 cases per 100 person-years among HIV seronegative men (rate ratio = 4.11; adjusted for age and body mass index), during the 4 year observation period, based on a median follow-up of 2.3 years. Conclusion: The incidence of DM in HIV-infected men with exposure of protease inhibitors was greater than 4 times that of HIV-seronegative men, representing a risk that is higher than previous estimates.