Protease inhibitors and diabetes

Diabetes is considered a relatively rare side-effect of protease inhibitors. One study reported 1.4% developed high blood glucose at one year. Another study reported a 4% rate of diabetes and an 8% rate of glucose intolerance. The French APROCO cohort found that 10% of patients developed diabetes over three years of PI therapy, with incidence steady over time. ¹

A review of the WIHS cohort of 1785 women recruited in the US between 1994 and 1998 found that women receiving PI-containing HAART had an elevated risk of diabetes (2.8 cases per 100 patient years of treatment, compared to 1.4 in the HIV-negative group, 1.2 on NRTIs only and 1.2 on no HIV therapy). ²

However, recent research has identified combination antiretroviral therapy (HAART), co-infection with hepatitis C, baseline obesity or elevated blood sugar, and HIV infection itself as risk factors for hyperglycaemia and diabetes. Data from the Multicenter AIDS Cohort Study (MACS) show that PIs, d4T and efavirenz are all associated with the development of diabetes and hyperglycaemia in HIV-infected people on treatment. Compared to HIV-negative men, HIV-positive men not taking HAART were twice as likely to have diabetes, and HIV-positive men on HAART were five times more likely. Between 1999 and 2003, nearly 20% of the HIV-positive men on HAART developed hyperglycaemia and 11% developed diabetes. ^{3 4}

Other studies have also found diabetes more commonly among individuals with HIV. ⁵ However, others suggest that traditional risk factors for diabetes account for much of the risk in HIV-positive patients. ^{6 7 8} On balance, the role of HIV as a risk factor for diabetes remains unproven.