Background:  The risk of impaired glucose tolerance (IGT) and diabetes in HIV⁺ patients receiving HAART has not been well defined.

Methods:  We performed 2 oral glucose tolerance tests (OGTT) a median of 18.5 months (IQR 18.1 to 19.5) apart in 198 HIV⁺ and 125 at-risk HIV^­ adults without a history of diabetes at baseline. Standardized interviews were administered to assess sociodemographic and medical data including HAART use. Height and weight were measured. IGT was defined as fasting glucose <126 mg/dL and 2-hour glucose 140 to 199 mg/dL; diabetes was defined as fasting glucose ³126 mg/dL or 2-hour glucose ³200 mg/dL, or self-reported use of antidiabetic medication. c² tests and logistic regression analysis were performed to assess the associations of HIV and HAART (none vs protease inhibitor [PI] vs non-PI) with incident abnormal glucose tolerance (IGT or diabetes).

Results:  Participants were 42% male, 55% black, and 32% Hispanic. At baseline, median age was 49 years (range 35 to 73); 34% were overweight (body mass index 25.0 to 29.9 kg/m²) and 31% obese (body mass index ³30.0 kg/m²). With no difference by HIV status, 46% reported a history of injection drug use (p = 0.98). Among HIV⁺ participants, 52% were on PI-HAART, 26% non-PI HAART, and 22% were HAART-naïve; median CD4⁺ count was 461 cells/mm³ (range 36 to 1369). On the baseline OGTT, of 323 participants, 23 (7%) had diabetes and an additional 51 (16%) had IGT. On follow-up, 4% (12 of 300) had incident diabetes; 10 of 12 were diagnosed by OGTT and 2 self-reported new use of antidiabetic medication. Of 249 participants without IGT or diabetes at baseline, 23 (9%) had incident abnormal glucose tolerance. There was no difference in the incidence of abnormal glucose tolerance by HIV status (8% for HIV⁺, 12% for HIV^­, p = 0.34), or among HIV⁺ participants, by HAART use (7% for no HAART, 9% for PI-HAART, 8% for non-PI HAART, p = NS). In a model including HIV status and HAART use, factors associated with incident abnormal glucose tolerance were age ³50 (OR_adj 3.9, 95%CI 1.4, 10.9) and obesity (OR_adj 3.2, 95%CI 1.3, 8.3).

Conclusions:  In this prospective study of mostly black or Hispanic older adults, classic diabetes risk factors, rather than HIV or HAART, predicted the development of abnormal glucose tolerance. In the HIV primary care setting, lifestyle interventions aimed at obtaining and maintaining a normal body weight should be implemented to reduce the risks of abnormal glucose tolerance and associated cardiovascular complications.