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Background:  Metabolic complications are increasingly common among HIV-infected patients.  More research is needed on factors that increase the risk of metabolic complications such as diabetes.

Methods:  We conducted a retrospective cohort study to examine predictors of developing type 2 diabetes (DM) in an urban HIV clinic from 1996 to 2003.  Subjects were included if they had at least 6 months of follow-up and no history of DM.  Logistic regression was used to examine the relationship between DM and clinical factors including hepatitis C virus (HCV) infection, history of pancreatitis, demographic characteristics, risk factor for HIV transmission, CD4 cell count, HIV-1 RNA level, and history of protease inhibitor (PI) therapy. 

Results:  Of 699 HIV-infected patients identified, 40 developed DM. A higher proportion of patients who developed DM had HCV infection (43% vs 23%, p <0.01), pancreatitis (13% vs 4%,  p = 0.01), were African American (45% vs 17%,  p <0.01), and were 40 years of age or older (55% vs 29%,  p <0.01).  In multivariate analysis controlling for other factors, patients with HCV infection had a 2.1-fold (95%CI:  1.1 to 4.2) increase and patients with a history of pancreatitis had a 3.1-fold (95%CI:  1.1 to 9.3) increase in the odds of developing DM compared with patients without HCV or pancreatitis.  African Americans had 3.0 times the odds (95%CI:  1.5 to 6.1) of DM compared with whites.  Age was not included in this model due to high collinearity with HCV infection but was an independent predictor of DM.  In a separate adjusted analysis each 1-year increase in age was associated with a 6% (95%CI:  1.01 to 1.1) increase in the odds of DM.  CD4 cell count, HIV-1 RNA level, gender, and history of PI therapy were not significantly associated with DM.  The majority of patients who developed DM had a history of acute rather than chronic pancreatitis. 

Conclusions:  While chronic pancreatitis is known to be associated with the development of DM in the general population, in this cohort a history of acute pancreatitis was associated with a large increase in risk of DM.  It may be important to limit other risks for DM such as considering PI-sparing antiretroviral therapy if patients are older, African American, have a history of pancreatitis, or HCV infection.  HCV infection may be especially important in patients over 40.

Keywords: diabetes; hepatitis C; pancreatitis