The Effects of Opiate Use and Hepatitis C Virus Infection on Risk of Diabetes Mellitus in the Women's Interagency HIV Study

Background:Opiate use is common in HIV-infected and hepatitis C virus (HCV)-infected individuals, however, its contribution to the risk of diabetes mellitus is not well understood. Methods:Prospective study of 1713 HIV-infected and 652 HIV-uninfected participants from the Women's Interagency HIV Study between October 2000 and March 2006. Diabetes defined as fasting glucose ≥126 mg/dL, self report of diabetes medication use, or confirmed diabetes diagnosis. Opiate use determined using an interviewer-administered questionnaire. Detectable plasma HCV RNA confirmed HCV infection. Results:Current opiate users had a higher prevalence of diabetes (15%) than nonusers (10%, P = 0.03), and a higher risk of incident diabetes (adjusted relative hazard: 1.58, 95% confidence interval: 1.01 to 2.46), after controlling for HCV infection, HIV/antiretroviral therapy status, and diabetes risk factors including age, race/ethnicity, family history of diabetes, and body mass index. HCV infection was also an independent risk factor for diabetes (adjusted relative hazard: 1.61, 95% confidence interval: 1.02 to 2.52). HCV-infected women reporting current opiate use had the highest diabetes incidence (4.83 cases per 100 person-years). Conclusions:Among women with or at-risk for HIV, opiate use is associated with increased diabetes risk independently of HCV infection. Diabetic screening should be part of care for opiate users and those infected with HCV.

[1]  P. O S I T I O N S T A T E M E N T,et al.  Diagnosis and Classification of Diabetes Mellitus , 2011, Diabetes Care.

[2]  Edward A Belongia,et al.  National Institutes of Health Consensus Development Conference Statement: management of hepatitis B. , 2009, Annals of internal medicine.

[3]  S. Cole,et al.  Antiretroviral therapy exposure and incidence of diabetes mellitus in the Women's Interagency HIV Study , 2007, AIDS.

[4]  Y. Lo,et al.  Hepatitis C virus infection is associated with insulin resistance among older adults with or at risk of HIV infection , 2007, AIDS.

[5]  P. Tien,et al.  Factors associated with seronegative chronic hepatitis C virus infection in HIV infection. , 2007, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[6]  Y. Lo,et al.  Abnormal glucose metabolism among older men with or at risk of HIV infection , 2006, HIV medicine.

[7]  A. Landay,et al.  Evaluating the impact of hepatitis C virus (HCV) on highly active antiretroviral therapy-mediated immune responses in HCV/HIV-coinfected women: role of HCV on expression of primed/memory T cells. , 2006, The Journal of infectious diseases.

[8]  S. Cole,et al.  Cumulative exposure to nucleoside analogue reverse transcriptase inhibitors is associated with insulin resistance markers in the Multicenter AIDS Cohort Study , 2005, AIDS.

[9]  M. Young,et al.  The Women's Interagency HIV Study: an Observational Cohort Brings Clinical Sciences to the Bench , 2005, Clinical Diagnostic Laboratory Immunology.

[10]  M. Gerschenson,et al.  Insulin resistance in the HIV-infected population: the potential role of mitochondrial dysfunction. , 2005, Current drug targets. Infectious disorders.

[11]  Stephen R Cole,et al.  Antiretroviral therapy and the prevalence and incidence of diabetes mellitus in the multicenter AIDS cohort study. , 2005, Archives of internal medicine.

[12]  Y. Lo,et al.  Disorders of glucose metabolism among HIV-infected women. , 2005, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[13]  R. Parker,et al.  The effects of HIV protease inhibitors atazanavir and lopinavir/ritonavir on insulin sensitivity in HIV-seronegative healthy adults , 2004, AIDS.

[14]  T. Kawaguchi,et al.  Hepatitis C virus down-regulates insulin receptor substrates 1 and 2 through up-regulation of suppressor of cytokine signaling 3. , 2004, The American journal of pathology.

[15]  M. Schambelan,et al.  The metabolic effects of lopinavir/ritonavir in HIV-negative men , 2004, AIDS.

[16]  K. Koike,et al.  Hepatitis C virus infection and diabetes: direct involvement of the virus in the development of insulin resistance. , 2004, Gastroenterology.

[17]  S. Aytug,et al.  Impaired IRS‐1/PI3‐kinase signaling in patients with HCV: A mechanism for increased prevalence of type 2 diabetes , 2003, Hepatology.

[18]  J. Robins,et al.  Effect of highly active antiretroviral therapy on time to acquired immunodeficiency syndrome or death using marginal structural models. , 2003, American journal of epidemiology.

[19]  B. Kieffer,et al.  Morphine Induces Desensitization of Insulin Receptor Signaling , 2003, Molecular and Cellular Biology.

[20]  Richard D Moore,et al.  The Effect of HAART and HCV Infection on the Development of Hyperglycemia Among HIV‐Infected Persons , 2003, Journal of acquired immune deficiency syndromes.

[21]  J. Pankow,et al.  Hepatitis C virus infection and incident type 2 diabetes , 2003, Hepatology.

[22]  R. Klein,et al.  Association of hepatitis C infection and antiretroviral use with diabetes mellitus in drug users. , 2003, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[23]  K. H. Hullsiek,et al.  Prevalence and characteristics of hepatitis C virus coinfection in a human immunodeficiency virus clinical trials group: the Terry Beirn Community Programs for Clinical Research on AIDS. , 2003, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[24]  A. Moorman,et al.  Influence of coinfection with hepatitis C virus on morbidity and mortality due to human immunodeficiency virus infection in the era of highly active antiretroviral therapy. , 2003, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[25]  M. Schambelan,et al.  Metabolic effects of indinavir in healthy HIV-seronegative men , 2001, AIDS.

[26]  E L Murphy,et al.  Prevalence of hepatitis C virus infection in the United States. , 1999, The New England journal of medicine.

[27]  H. Margolis,et al.  The prevalence of hepatitis C virus infection in the United States, 1988 through 1994. , 1999, The New England journal of medicine.

[28]  J. Stoker,et al.  The Department of Health and Human Services. , 1999, Home healthcare nurse.

[29]  J. Rakela,et al.  Search for hepatitis C virus extrahepatic replication sites in patients with acquired immunodeficiency syndrome: Specific detection of negative‐strand viral rna in various tissues , 1998, Hepatology.

[30]  Joseph Feldman,et al.  The Women's Interagency HIV Study , 1998 .

[31]  Eugene R. Schiff,et al.  National Institutes of Health Consensus Development Conference Panel statement: Management of hepatitis C , 1997, Hepatology.

[32]  A. Floreani,et al.  Development of type 1 diabetes mellitus during interferon alfa therapy for chronic HCV hepatitis , 1992, The Lancet.

[33]  R. Torella,et al.  Impaired Glucose Metabolism in Heroin and Methadone Users , 1987, Hormone and metabolic research = Hormon- und Stoffwechselforschung = Hormones et metabolisme.

[34]  R. Torella,et al.  Glucose tolerance and hormonal responses in heroin addicts. A possible role for endogenous opiates in the pathogenesis of non-insulin-dependent diabetes. , 1983, Metabolism: clinical and experimental.

[35]  A. Ghodse,et al.  Oral Glucose Tolerance and Hormonal Response in Heroin-dependent Males , 1973, British medical journal.

[36]  John W. Mellors,et al.  Panel on Clinical Practices for Treatment of HIV Infection , 2000 .

[37]  J. Emparanza,et al.  [The prevalence of hepatitis C virus infection]. , 1998, Gastroenterologia y hepatologia.

[38]  D. Sadava,et al.  Effect of methadone addiction on glucose metabolism in rats. , 1997, General pharmacology.

[39]  R. Jorde,et al.  Increments in glucose, glucagon and insulin after morphine in rats, and naloxone blocking of this effect. , 1992, Life sciences.