Case-control study of diabetes mellitus in HIV-infected patients

Background: Diabetes mellitus (DM) is more prevalent among patients with HIV infection. Besides protease inhibitors (PIs), other factors may contribute to the development of DM. Objective: To assess characteristics associated with the development of DM in HIV-infected persons. Methods: We conducted a case-control study in an urban HIV clinic among patients with incident DM (49 cases) matched to 2 controls (n = 98) on age 5 years, race, sex, and length of clinic follow-up. There was a second set of unmatched controls (n = 196). Results: Compared with matched controls, case patients had higher mean body mass index (BMI; 30.0 vs. 25.3 kg/m(2), matched odds ratio [OR] = 1.20; P < 0.001), higher alanine aminotransferase (ALT; 66 vs. 44 U/L, OR = 1.12 per 10 U/L; P = 0.013), and stronger family history of DM (50% vs. 29%, OR = 3.30; P = 0.009). Hepatitic C virus coinfection and PI use were not significant factors. In unmatched controls, there was no significant difference in age, sex, or ethnicity. In multivariate analyses, BMI (OR = 1.13 per kg/m(2); P = 0.012), family history (OR = 5.55; P = 0.014), and ALT (OR = 1.16; P = 0.012) were associated with DM. Conclusion: These findings suggest a complex interaction among genetic factors, body composition, and liver injury in the pathogenesis of DM in HIV-infected patients.