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Predicting diabetes risk among HIV-positive and HIV-negative women

Galaviz, Karla I.a; Schneider, Michael F.b; Tien, Phyllis C.c,d; Mehta, C. Christinae; Ofotokun, Ighovwerhaf; Colasanti, Jonathana,f; Marconi, Vincent C.a,f; Palar, Kartikac; Wingood, Ginag; Adimora, Adaora A.h; Alcaide, Mariai; Cohen, Mardge H.j; Gustafson, Deborahk; Karim, Roksanal; Konkle-Parker, Deborahm; Merenstein, Danieln; Sharma, Anjalio; Ali, Mohammed K.a

doi: 10.1097/QAD.0000000000002017
Epidemiology and Social

Objective: To assess the performance of an adapted American Diabetes Association (ADA) risk score and the concise Finnish Diabetes Risk Score (FINRISC) for predicting type 2 diabetes development in women with and at risk of HIV infection.

Design: Longitudinal analysis of the Women's Interagency HIV Study.

Methods: The women's Interagency HIV Study is an ongoing prospective cohort study of women with and at risk for HIV infection. Women without prevalent diabetes and 3-year data on fasting blood glucose, hemoglobin A1c, self-reported diabetes medication use, and self-reported diabetes were included. ADA and FINRISC scores were computed at baseline and their ability to predict diabetes development within 3 years was assessed [sensitivity, specificity and area under the receiver operating characteristics (AUROC) curve].

Results: A total of 1111 HIV-positive (median age 41, 60% African American) and 454 HIV-negative women (median age 38, 63% African-American) were included. ADA sensitivity did not differ between HIV-positive (77%) and HIV-negative women (81%), while specificity was better in HIV-negative women (42 vs. 49%, P = 0.006). Overall ADA discrimination was suboptimal in both HIV-positive [AUROC = 0.64 (95% CI: 0.58, 0.70)] and HIV-negative women [AUROC = 0.67 (95% CI: 0.57, 0.77)]. FINRISC sensitivity and specificity did not differ between HIV-positive (72 and 49%, respectively) and HIV-negative women (86 and 52%, respectively). Overall FINRISC discrimination was suboptimal in HIV-positive [AUROC = 0.68 (95% CI: 0.62, 0.75)] and HIV-negative women [AUROC = 0.78 (95% CI: 0.66, 0.90)].

Conclusion: Model performance was suboptimal in women with and at risk of HIV, while greater misclassification was generally observed among HIV-positive women. HIV-specific risk factors known to contribute to diabetes risk should be explored in these models.

aHubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia

bDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

cDivision of Infectious Diseases, Department of Medicine, University of California-San Francisco

dDepartment of Veterans Affairs, San Francisco, California

eDepartment of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University

fDivision of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia

gDepartment of Sociomedical Sciences, Lerner Center for Public Health Promotion, Mailman School of Public Health at Columbia University, New York, New York

hDivision of Infectious Disease, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

iDivision of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida

jDepartment of Medicine, Stroger Hospital and Rush University, Chicago, Illinois

kDepartment of Neurology (D.G.), SUNY-Downstate Medical Center, Brooklyn, New York

lDepartment of Preventive Medicine, University of Southern California, Los Angeles, California

mUniversity of Mississippi Medical Center, Jackson, Mississippi

nDepartment of Family Medicine, Georgetown University Medical Center, Washington, District of Columbia

oDepartment of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA.

Correspondence to Karla I. Galaviz, Assistant Professor, Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, CNR Building Room 7041, Atlanta, Georgia, USA. Tel: +1 404 727 9776; e-mail:

Received 4 June, 2018

Accepted 27 July, 2018

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