August 10, 2007

Nukes, not PIs, Tied to Diabetes in Positive Women

Long-term use of nucleoside reverse transcriptase inhibitors (NRTIs) is linked to an increased risk of diabetes in HIV-positive women, according to new data published by researchers with the Women’s HIV Interagency Study (WIHS). But remaining on a protease inhibitor (PI)—drugs that have been associated with diabetes in previous studies involving both men and women—did not affect the likelihood of the life-threatening disease occurring. Prolonged non-nucleoside reverse transcriptase inhibitor(NNRTI) use was also off the hook.

It’s still not clear how NRTIs impair the body’s ability to process sugar (glucose), writes Phyllis Tien, MD, of the University of California, San Francisco, and her colleagues in the August 20 issue of AIDS. The authors point out that these drugs have been fingered as a cause of lipoatrophy, which has also been tied to insulin resistance—a condition that can lead to diabetes.

The lack of a connection between PI use and diabetes in the study comparing 116 HIV-positive women to 36 HIV-negative women may be due to changing patterns in the specific drugs used. The authors point to research suggesting that current options, such as Kaletra (lopinavir plus ritonavir), may have less of a cumulative effect on cells’ sensitivity to insulin than Crixivan (indinavir), a popular PI option in the late 1990s.

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