The risk of developing diabetes appears to be slightly higher among PLWH treated with INSTIs or protease inhibitors than with NNRTIs, a difference that can almost entirely be explained by weight gain, researchers reported in Clinical Infectious Diseases.
The study analyzed a decade’s worth of data on 22,884 participants in the NA-ACCORD cohort who started HIV treatment between 2007 and 2017. Forty-seven percent took NNRTIs, 30% were on PIs and 23% on INSTIs. Overall, 3% of participants developed diabetes mellitus, about twice the rate in the general population.
Compared to people on NNRTIs, the diabetes hazard ratio for people on INSTIs was 1.17, and for people on PIs it was 1.27. Adjusting for weight change over the preceding 12 months attenuated most, though not quite all, of the higher risk. Participants taking raltegravir (Isentress) were particularly prone to developing diabetes (hazard ratio: 1.42).
Some of the observed differences between drug classes may be related to where fat is gained, the study authors theorized: The central fat accumulated on INSTIs may predispose people to diabetes more than weight gain elsewhere in the body, but other metabolic effects may also be at play, they stated.
The analysis was based on prescribed medications and did not account for lifestyle factors, such as smoking or physical activity levels, nor did it consider diabetes treated entirely with lifestyle changes.
Of note, the cohort includes relatively few women (14% of participants), and only consists of people living in the U.S. or Canada.