Metabolic Disorders in HIV-Infected Adolescents Receiving Protease Inhibitors
Table 5
Clinical characteristics of patients and risk factors for prediabetes and type 2 diabetes mellitus in HIV-infected adolescents receiving protease inhibitor- (PI-) based highly active antiretroviral therapy (HAART).
Characteristics and factors
Prediabetes/T2DM ()
Normal glucose level ()
Univariate analysis
Multivariate analysis
Crude OR (95% CI)
p value
Adjusted OR (95% CI)
p value
Demographics and anthropometrics
Age (years), median (IQR)
16.9 (14.5–19.1)
16.6 (14.6–17.8)
1.04 (0.9–1.2)
0.603
Gender, (%)
Male
13 (65.0)
29 (48.3)
2.0 (0.7–5.7)
0.200
4.16 (0.87–19.78)
0.073
Female
7 (35.0)
31 (51.7)
1
1
Family history of T2DM, (%)
Yes
7 (35.0)
17 (28.3)
1.4 (0.5–4.0)
0.574
No
16 (65.0)
43 (71.7)
1
Waist circumference (cm), median (IQR)
75.25 (61–82)
66.65 (63.1–70.1)
1.06 (1.01–1.12)
0.027
BMI (kg/m2), median (IQR)
19.3 (15.7–23.4)
17.8 (16.5–19.7)
1.18 (1.01–1.37)
0.035
Percentage weight-for-height (%), median (IQR)
107.3 (96.7–128.5)
98.5 (87.8–107.7)
1.03 (1.00–1.07)
0.028
Waist-to-height ratio, median (IQR)
0.48 (0.41–0.53)
0.44 (0.40–0.46)
7210.9 (1.1–4.71 × 107)
0.047
Obesity, (%)
8 (40.0)
7 (11.7)
5.0 (1.5–16.6)
0.008
7.71 (1.36–43.7)
0.021
High blood pressure, (%)
Yes
4 (20.0)
3 (5.0)
4.8 (0.96–23.44)
0.056
No
16 (80.0)
57 (95.0)
1
Acanthosis nigricans, (%)
7 (35.0)
4 (6.7)
7.5 (1.9–29.6)
0.004
Lipoatrophy, (%)
8 (40.0)
14 (23.3)
2.2 (0.7–6.4)
0.153
Lipohypertrophy, (%)
7 (35.0)
1 (1.7)
31.8 (3.6–280.9)
0.002
62.9 (4.97–795.6)
0.001
Lipodystrophy, (%)
11 (55.0)
15 (25.0)
3.7 (1.3–10.6)
0.016
Tanner staging, (%)
Pre-pubertal stage
2 (10.0)
3 (5.0)
1
Pubertal stage
18 (90.0)
57 (95.0)
0.5 (0.1–3.1)
0.433
Metabolic parameters
Total cholesterol (mmol/L), median (IQR)
4.66 (4.12–5.97)
4.35 (3.90–4.99)
1.01 (1.0–1.02)
0.030
Triglycerides (mmol/L), median (IQR)
1.70 (1.24–3.35)
1.48 (1.03–2.72)
1.0 (0.99–1.00)
0.075
LDL-cholesterol (mmol/L), median (IQR)
2.34 (2.06–3.73)
2.43 (2.05–2.87)
1.0 (0.99–1.02)
0.218
HDL-cholesterol (mmol/L), median (IQR)
1.17 (1.05–1.36)
1.19 (0.10–1.42)
1.0 (0.97–1.02)
0.997
FPG (mmol/L), median (IQR)
5.02 (4.50–5.52)
4.60 (4.39–4.88)
1.12 (1.03–1.22)
0.007
2-hour PG (mmol/L), median (IQR)
8.82 (8.05–9.94)
6.11 (5.33–6.88)
1.19 (1.08–1.31)
0.001
Fasting insulin (pmol/L), median (IQR)
156 (70–301)
90 (55–122)
1.05 (1.01–1.08)
0.012
2-hour insulin (pmol/L), median (IQR)
1611 (812–3775)
543 (357–1058)
1.005 (1.002–1.008)
0.001
HOMA-IR, median (IQR)
5.0 (2.8–10.1)
2.6 (1.6–3.6)
1.26 (1.06–1.49)
0.007
HbA1c (%), median (IQR)
5.2 (4.9–5.5)
5.2 (4.9–5.5)
1.9 (0.7–5.2)
0.205
HIV-specific disease characteristic
CDC stage, (%)
Severely symptomatic (stage C)
5 (25.0)
20 (33.3)
0.7 (0.2–2.1)
0.488
Nonsevere stage
15 (75.0)
40 (66.7)
1
Nadir CD4 cell count (cells/mm3), median (IQR)
188.5 (36–392.5)
161 (33–389)
1.00 (0.99–1.00)
0.851
<100 cells/mm3, (%)
6 (30.0)
25 (42.4)
1
100–350 cells/mm3, (%)
8 (40.0)
18 (30.5)
1.8 (0.5–6.3)
0.322
>350 cells/mm3, (%)
6 (30.0)
16 (27.1)
1.6 (0.4–5.7)
0.499
CD4 cell count (cells/mm3), median (IQR)
766.5 (597–936.5)
624 (502–753.5)
1.00 (0.99–1.00)
0.121
1.002 (0.99–1.00)
0.061
<350 cells/mm3, (%)
1 (5.0)
9 (15.0)
1
350–500 cells/mm3, (%)
1 (5.0)
6 (10.0)
1.5 (0.1–28.9)
0.788
>500 cells/mm3, (%)
18 (90.0)
45 (75.0)
3.6 (0.4–30.5)
0.240
Viral load (copies/mL), median (IQR)
40 (40-40)
40 (40-40)
1.0 (1.0–1.0)
0.475
≤40 copies/mL, (%)
18 (90.0)
46 (76.7)
2.7 (0.6–13.3)
0.211
>40 copies/mL, (%)
2 (10.0)
14 (23.3)
1
Duration of PIs (months), median (IQR)
73.8 (58.6–82.1)
72.5 (50.8–81.2)
1.00 (0.99–1.02)
0.389
Duration of HAART (months), median (IQR)
119.9 (82.1–128.1)
106.2 (77.0–130.9)
1.00 (0.99–1.02)
0.609
Ever received didanosine ≥ 6 months, (%)
15 (75.0)
41 (68.3)
1.4 (0.4–4.4)
0.574
Ever received stavudine ≥ 6 months, (%)
16 (80.0)
35 (58.3)
2.8 (0.8–9.6)
0.089
8.18 (1.37–48.7)
0.021
Ever received tenofovir ≥ 6 months, (%)
11 (55.0)
46 (76.7)
0.37 (0.13–1.08)
0.069
0.17 (0.04–0.78)
0.022
Ever received zidovudine ≥ 6 months, (%)
20 (100.0)
53 (88.3)
—
—
Ever received efavirenz ≥ 6 months, (%)
9 (45.0)
34 (56.7)
0.6 (0.2–1.7)
0.367
Ever received nevirapine ≥ 6 months, (%)
10 (50.0)
24 (40.0)
1.5 (0.5–4.1)
0.435
Ever received lopinavir/ritonavir ≥ 6 months, (%)
20 (100.0)
59 (98.3)
—
—
Ever received atazanavir ≥ 6 months, (%)
8 (40.0)
15 (25.0)
2 (0.7–5.8)
0.204
Ever received darunavir ≥ 6 months, (%)
5 (25.0)
8 (13.3)
2.2 (0.6–7.6)
0.228
Ever received indinavir ≥ 6 months, (%)
14 (70.0)
26 (43.3)
3.05 (1.03–9.0)
0.044
2.6 (0.68–10.3)
0.159
Ever received full dose ritonavir ≥ 6 months, (%)
1 (5.0)
7 (11.7)
0.4 (0.05–3.4)
0.404
Input variables: gender, Tanner stage, family history of T2DM, obesity, lipohypertrophy, current CD4 cell count, exposure to stavudine for at least 6 months, exposure to tenofovir for at least 6 months, and exposure to indinavir for at least 6 months. Viral load ≤ 40 copies/mL was expressed as 40 in the statistical analysis. OR, odds ratio; CI, confidence interval; IQR, interquartile range; T2DM, type 2 diabetes mellitus; SBP, systolic blood pressure; DBP, diastolic blood pressure; CDC, Centers for Disease Control; FPG, fasting plasma glucose; PG, plasma glucose.
