Prevalence and predictors of glucose metabolism disorders among People Living with HIV on combination antiretroviral therapy

Abstract

Objective We investigated prevalence and predictors of glucose metabolism disorders (GMDs) among People Living with HIV (PLWH) on efavirenz- and atazanavir/ritonavir-based combination antiretroviral therapy (cART). Methods This cross-sectional study involved adult PLWH on efavirenz- (n = 240) and atazanavir/ritonavir-based (n = 111) cART. The prevalence of GMDs was determined by fasting serum glucose, insulin, and homeostasis model assessment. A logistic regression model was used to determine predictors. Results The overall prevalence of GMDs for all regimens was 27.6% (97/351) [95% CI 23.0–32.6%] s, with 31.1% (75/240) [95% CI 25.4–37.5%] for efavirenz-based and 19.8% (22/111) [95% CI 12.9–28.5%)] for atazanavir/ritonavir-based cART group. The prevalence of impaired fasting glycemia was significantly higher (p = 0.026) in the efavirenz- [(15.4%) (37/240); 95%CI (11.1–20.6%)] than atazanavir/ritonavir-based [(7.2%) (8/111), (95%CI (3.2–13.7%)] cART. However, no significant difference was observed in the prevalence of diabetes mellitus and insulin resistance between the two regimens. Age ≥46 years old and specific type of ARV contained in cART, such as TDF, were independent predictors of GMD in both groups. Whereas the male gender and BMI category were predictors of GMDs among EFV-based cART group, AZT- and ABC- containing regimens and triglyceride levels were predictors in the ATV/r-based group. Conclusions GMDs were highly prevalent among adults on EFV- than ATV/r-based cARTs. Age ≥46 years and TDF-containing cARTs are common predictors in both regimens. Close monitoring for impaired fasting glucose during long-term EFV-based cART is recommended for early diagnosis of type-2 diabetes and management.

CYP3A and CYP2B6 Genotype Predicts Glucose Metabolism Disorder among HIV Patients on Long-Term Efavirenz-Based ART: A Case-Control Study

“…The study design was a case-control genotype association study, and the study population is described in our previous cross-sectional study [ 11 ]. In brief, a total of 240 participants on long-term EFV-based ART regimens with complete genotyping and GMD data participated in this study.…”

“…In brief, a total of 240 participants on long-term EFV-based ART regimens with complete genotyping and GMD data participated in this study. The inclusion and exclusion criteria were stated in detail in our previous publication [ 11 ]. In brief, PLWH on EFV-based cART at least for one year with age ≥ 18 years were included, while PLWH diagnosed with DM, pregnancy, cancer, renal disease, liver disease, uncontrolled hypertension, or heart failure were excluded from this study.…”

“…Controls were those individuals with normal fasting serum glucose, HOMA-IR, or serum insulin level based on the above-stated cut-off values as stated by Tadesse et al [ 11 ]. The cases were those individuals with at least one diagnosis with insulin resistance, impaired fasting glycemia, or diabetes mellitus.…”

“…Various observational and clinical trial studies link EFV use with a range of treatment-associated adverse events manifested depending on the duration of therapy. While liver enzyme abnormalities [ 3 , 4 , 5 , 6 ] and neuropsychological manifestations [ 7 , 8 ] can occur during early treatment, HIV patients on long-term antiretroviral therapy are at an increased risk of developing metabolic derangements, including lipid dystrophy and glucose metabolism disorders (GMDs) [ 9 , 10 , 11 ]. Indeed, a higher risk of GMDs among HIV patients on EFV-based cART than on atazanavir/ritonavir-based cART has been reported recently [ 11 ].…”

“…Accumulating evidence in the literature indicates that long-term efavirenz-based cARTs are associated with GMDs in PLWH [ 11 , 21 , 22 ]. The importance of pharmacogenetic variations for cART-induced liver and CNS toxicities is well explored.…”