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HIV patients who are coinfected with HCV and those who take a protease inhibitor are at increased risk of hyperglycemia

Use of highly active antiretroviral therapy (HAART) has substantially improved the health of HIV patients. However, a new study finds that HIV-infected people who are prescribed an HIV-1 protease inhibitor (PI) as part of their HAART regimen and those who are coinfected with hepatitis C virus (HCV), common among HIV-infected individuals, are at increased risk of developing hyperglycemia (high blood sugar levels) that can lead to diabetes. This finding supports previous reports showing an association between diabetes mellitus and PIs and HCV coinfection among HIV-infected patients.

In the study, which was supported in part by the Agency for Healthcare Research and Quality (HS07809), the researchers analyzed the prevalence of hyperglycemia among 1,230 patients on their first HAART regimen. They compared the prevalence and incidence of hyperglycemia (two random glucose levels over 220 mg/dL or documented diagnosis of diabetes) among people with and without HCV infection while on a PI-containing HAART regimen, a nonnucleoside reverse transcriptase inhibitor (NNRTI)-containing regimen, or a regimen that contained both a PI and an NNRTI. They followed the patients from January 1996 through May 2002 at an urban HIV hospital clinic.

The prevalence of hyperglycemia was significantly higher in the HCV-coinfected patients (5.9 percent) compared with the HCV-uninfected patients (3.3 percent). Among people receiving HAART, those coinfected with HCV had 2.2 times greater risk and those on a PI had a five times greater risk of developing hyperglycemia. The incidence of hyperglycemia was highest among HCV-coinfected patients receiving a PI (5.6 cases per 100-person years), suggesting an additive effect of either a PI or HCV on hyperglycemia.

See "The effect of HAART and HCV infection on the development of hyperglycemia among HIV-infected persons," by Shruti H. Mehta, Ph.D., Richard D. Moore, M.D., David L. Thomas, M.D., and others, in the August 15, 2003, Journal of Acquired Immune Deficiency Syndromes 33(5), pp. 577-584.

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