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. 2020 Oct 7;7(12):ofaa470.
doi: 10.1093/ofid/ofaa470. eCollection 2020 Dec.

Influence of Hepatitis C Coinfection and Treatment on Risk of Diabetes Mellitus in HIV-Positive Persons

Amanda Mocroft  1 , Jens D Lundgren  2 , Juergen K Rockstroh  3 , Inka Aho  4 , Gilles Wandeler  5 , Lars Nielsen  6 , Simon Edwards  7 , Jean-Paul Viard  8 , Karine Lacombe  9 , Gerd Fätkenheuer  10 , Giovanni Guaraldi  11 , Montserrat Laguno  12 , Josep Llibre  13 , Hila Elinav  14 , Leo Flamholc  15 , Martin Gisinger  16 , Dzmitry Paduta  17 , Irina Khromova  18 , David Jilich  19 , Blazej Rozplochowski  20 , Cristiana Oprea  21 , Lars Peters  1 ; EuroSIDA study
Collaborators, Affiliations

Influence of Hepatitis C Coinfection and Treatment on Risk of Diabetes Mellitus in HIV-Positive Persons

Amanda Mocroft et al. Open Forum Infect Dis. .

Abstract

Background: The role of hepatitis C virus (HCV) coinfection and HCV-RNA in the development of diabetes mellitus (DM) in HIV-positive persons remains unclear.

Methods: Poisson regression was used to compare incidence rates of DM (blood glucose >11.1 mmol/L, HbA1C >6.5% or >48 mmol/mol, starting antidiabetic medicine or physician reported date of DM onset) between current HIV/HCV groups (anti-HCV-negative, spontaneously cleared HCV, chronic untreated HCV, successfully treated HCV, HCV-RNA-positive after HCV treatment).

Results: A total of 16 099 persons were included; at baseline 10 091 (62.7%) were HCV-Ab-negative, 722 (4.5%) were spontaneous clearers, 3614 (22.4%) were chronically infected, 912 (5.7%) had been successfully treated, and 760 (4.7%) were HCV-RNA-positive after treatment. During 136 084 person-years of follow-up (PYFU; median [interquartile range], 6.9 [3.6-13.2]), 1108 (6.9%) developed DM (crude incidence rate, 8.1/1000 PYFU; 95% CI, 7.7-8.6). After adjustment, there was no difference between the 5 HCV strata in incidence of DM (global P = .33). Hypertension (22.2%; 95% CI, 17.5%-26.2%) and body mass index >25 (22.0%; 95% CI, 10.4%-29.7%) had the largest population-attributable fractions for DM.

Conclusions: HCV coinfection and HCV cure were not associated with DM in this large study. The biggest modifiable risk factors were hypertension and obesity, and continued efforts to manage such comorbidities should be prioritized.

Keywords: HIV; diabetes mellitus; direct-acting antivirals; hepatitis C; sustained virologic response.

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Figures

Figure 1.
Figure 1.
Factors associated with incidence of diabetes mellitus. Adjusted for factors shown and gender, HIV transmission risk group, nadir CD4, baseline date, glucose and HbA1C levels (as fixed values at baseline), HBsAg, cumulative exposure to zidovudine, stavudine, and didanosine, HIV viral load, CD4, smoking, chronic kidney disease as time-updated. aIncluded as time-updated variables. DM was defined as either blood glucose >11.1 mmol/L, HbA1C >6.5%, or >48 mmol/mol, starting antidiabetic medicine, or physician-reported date of DM onset. Abbreviations: DM, diabetes mellitus; HCV, hepatitis C virus.
Figure 2.
Figure 2.
Multivariate incidence rate ratios of diabetes mellitus: Stratification by age. Adjusted for factors shown and gender, ethnic origin, HIV transmission risk group, region, nadir CD4, baseline date, glucose and HbA1C levels (as fixed values at baseline), HBsAg, cumulative exposure to zidovudine, stavudine, and didanosine, HIV viral load, CD4, smoking, AIDS, cardiovascular disease, non-AIDS-defining malignancies, end-stage liver disease, hypertension, liver fibrosis, chronic kidney disease, and body mass index as time-updated. DM was defined as either blood glucose >11.1 mmol/L, HbA1C >6.5%, or >48 mmol/mol, starting antidiabetic medicine, or physician-reported date of DM onset. Abbreviations: DM, diabetes mellitus; HCV, hepatitis C virus.
Figure 3.
Figure 3.
Population-attributable fractions for diabetes mellitus. Adjusted for gender, ethnic origin, HIV transmission risk group, region, nadir CD4, baseline date, glucose and HbA1C levels (as fixed values at baseline), HCV strata, HBsAg, cumulative exposure to zidovudine, stavudine, and didanosine, HIV viral load, CD4, smoking, AIDS, cardiovascular disease, non-AIDS-defining malignancies, end-stage liver disease, hypertension, liver fibrosis, chronic kidney disease, and body mass index as time-updated. DM was defined as either blood glucose >11.1 mmol/L, HbA1C >6.5%, or >48 mmol/mol, starting antidiabetic medicine, or physician-reported date of DM onset. Abbreviations: DM, diabetes mellitus; HCV, hepatitis C virus; PAF, population-attributable fraction.
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