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Impaired Glucose Tolerance in HIV-Positive Patients Receiving and Those Not Receiving Protease Inhibitors

TO THE EDITOR: Data on the incidence of diabetes mellitus in HIV-positive patients receiving protease inhibitors are conflicting (1-4). To determine the prevalence of impaired glucose tolerance and diabetes in HIV-positive patients and to identify risk factors, we retrospectively reviewed the patient charts of an HIV outpatient clinic in 1997. Antiretroviral treatment consisted of reverse transcriptase inhibitors (didanosine, lamivudine, nevirapine, stavudine, zalcitabine, and zidovudine) and protease inhibitors (indinavir, nelfinavir, ritonavir, and saquinavir). Impaired glucose tolerance was defined as a serum glucose level greater than 140 mg/dL, and diabetes was defined as a serum glucose level greater than 180 mg/mL. This definition was used so that the prevalence of impaired glucose tolerance or diabetes was not overestimated (5). For statistical analysis, we used the Fisher exact test. Among 783 evaluable patients, 336 received protease inhibitors and 265 received regimens containing only reverse transcriptase inhibitors (Table). One hundred eighty-two patients received no antiretroviral treatment. Eighty-four patients (10.7%) had at least two serum glucose levels greater than 140 mg/dL. Of these, 26 (3.3%) had a serum glucose level greater than 180 mg/dL. Treatment with protease inhibitors was associated with impaired glucose tolerance (P<0.005) but not with diabetes. Impaired glucose tolerance was found in 17 of 182 (9%) patients receiving nelfinavir, 17 of 109 (16%) receiving indinavir, 4 of 45 (9%) receiving saquinavir, 3 of 14 (21%) receiving ritonavir, and 3 of 29 (10%) receiving ritonavir plus saquinavir (P>0.05). Table. Proportions of HIV-Positive Patients with Elevated Serum Glucose Levels according to Antiretroviral Treatment Category Hyperglycemia, but not diabetes, was more frequent in men than in women (12% compared with 3%; P<0.002). The median age of patients with impaired glucose tolerance (45.5 years) or diabetes (48 years) was higher than the median age of the entire study sample (37 years) (P<0.05). In conclusion, treatment with protease inhibitors, male sex, and older age are risk factors for impaired glucose tolerance. Only age, not treatment with protease inhibitors, was identified as a risk factor for diabetes.