Objective: To analyze the association between chronic hepatitis C virus (HCV) and cytomegalovirus (CMV) infections with type 2 diabetes in HIV-infected patients.
Methods: HIV-1-infected patients enrolled in ICONA, a prospective cohort study involving 42 tertiary care centers in Italy, were selected with the following characteristics: for the diabetes incidence analysis, all patients with available CMV IgG results (first available test = baseline) and without type 2 diabetes were followed until onset of type 2 diabetes, last available clinical follow-up, death or September 30, 2014, whichever occurred first; for the prevalence analysis, all ICONA patients were analyzed at their last follow-up visit. Main outcome measures were the new onset of type 2 diabetes (incidence analysis) and the prevalence of type 2 diabetes at last follow-up.
Results: During 38,062 person-years of follow-up (PYFU) in 6505 individuals, we observed 140 cases of incident type 2 diabetes (Incidence rate 3.7, 95% CI: 3.1 to 4.3, per 1000 PYFU). In a multivariable Poisson regression model, HCV-antibody (Ab)+/HCV RNA+ patients [adjusted relative rate versus HCV-Ab negative 1.73 (95% CI: 1.08 to 2.78)] but not HCV Ab+RNA− or CMV IgG+ patients, had a higher risk of diabetes. Among 12,001 patients, 306 (2.5%) prevalent cases of type 2 diabetes were detected. HCV Ab+RNA+ status was independently associated with prevalent diabetes (adjusted Odds Ratio vs HCV Ab− 2.49; 95% CI: 1.08 to 5.74), whereas HCV-Ab+/HCV RNA− and CMV IgG+ status were not.
Conclusion: In HIV-infected individuals, active HCV replication but not prior HCV exposure or latent CMV infection is associated with incident and prevalent type 2 diabetes.
*Dipartimento di Biotecnologie Mediche, Università degli Studi di Siena;
†UOC Malattie Infettive Universitarie ed Epatologia, Dipartimento di Medicina Interna e Specialistica, Azienda Ospedaliera Universitaria Senese, Siena, Italy;
‡National Institute for Infectious Diseases “L Spallanzani, Roma, Italy;
§Division of Infectious Diseases, Hospital San Raffaele, Milan, Italy;
‖Division of Infectious Diseases, Niguarda Hospital, Milan, Italy;
¶Department of Infectious Diseases, University of Brescia, Brescia, Italy;
#Division of Infectious Diseases, AO Giovanni XXIII, Bergamo, Italy;
**Division of Infectious Diseases, University La Sapienza, Polo Pontino, Latina, Italy;
††INMI “L Spallanzani,” Rome, Italy;
‡‡Division of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy;
§§Division of Infectious Diseases, University La Sapienza, Polo Pontino, Latina, Italy; and
‖‖Division of Infectious Diseases, University of Milan, San Paolo Hospital, Milan, Italy.
Correspondence to: Andrea De Luca, MD, UOC Malattie Infettive Universitarie e Malattie Infettive ed Epatologia, AOU Senese, Viale M Bracci 16—53100 Siena, Italy (e-mail: andrea.deluca@unisi.it).
ICONA Foundation received unrestricted grants from Abbvie, BMS; Gilead, Janssen, MSD and ViiV Italy.
Preliminary findings of this analysis have been presented at the EACS Conference, Barcelona, Spain, October 21–24, 2015, abstract PE15/80.
A.D.L. was a member of advisory boards or a paid consultant for ViiV Healthcare, Gilead Sciences, Abbvie, Bristol-Myers Squibb, Janssen, Merck; A.C. was a consultant for ViiV Healthcare, Gilead Sciences, Abbvie, Bristol-Myers Squibb, Janssen, Merck; M.P. was a consultant for Gilead Sciences, Abbvie, Bristol-Myers Squibb, Janssen and Merck; N.G. was a consultant for ViiV Healthcare, Gilead Sciences, Abbvie, Bristol-Myers Squibb, Janssen, Merck; C.M. was member of advisory board or a paid consultant for ViiV Healthcare, Gilead Sciences, Abbvie, Bristol-Myers Squibb, Janssen, Merck; F.M. was a paid consultant or member of advisory boards for ViiV Healthcare, Gilead Sciences, Abbvie, Bristol-Myers Squibb, Janssen, Merck; A.A. was a paid consultant or member of advisory boards for ViiV Healthcare, Gilead Sciences, Abbvie, Bristol-Myers Squibb, Janssen, Merck; G.G. was a paid consultant or member of advisory boards for ViiV Healthcare, Gilead Sciences, Abbvie, Bristol-Myers Squibb, Janssen, Merck; A.d'M.A. was a paid consultant or member of advisory boards for ViiV Healthcare, Gilead Sciences, Abbvie, Bristol-Myers Squibb, Janssen, Merck; The remaining authors have no conflict of interests to disclose.
Members of the ICONA Foundation Study are listed in the Acknowledgements.
Received August 14, 2016
Accepted April 17, 2017
