82 had a higher BMI (P=0.019) and larger waist circumference (P=0.0003); higher levels of FPG (P=0.001), 2-h post-load glucose
(P=0.007), fasting insulin (P<0.0001), and 2-h post-load insulin (P=0.0003); and lower levels of total cholesterol (P=0.027) and HDL cholesterol (P=0.025). There were no between-group differences in terms of age (P=0.883) or gender (P=0.277); the number of years of antiretroviral exposure (P=0.672); the presence of previous AIDS-defining events (P=0.999), HCV infection (P=0.103) or HBV infection (P=0.265); the use of stavudine (P=0.814) or SB431542 mouse indinavir (P=0.513); CD4 cell count (P=0.591), CD4 percentage (P=0.424); or the level of triglycerides (P=0.954) or LDL cholesterol (P=0.973). Univariable analysis (Table 3) showed that a 1 mIU/L increase in fasting insulin level (OR 1.086; 95% CI 1.019–1.170; P=0.016) and a 0.5 unit increase in HOMA-IR (OR 1.240; 95% CI 1.050–1.495; P=0.014), as well as HOMA-IR values of >2.82, were associated with a higher risk of IGT or DM (OR 9.615; 95% CI 1.148–83.33; P=0.037). The first multivariable analysis (Table 3) showed that lower CD4 cell counts [adjusted odds ratio
(AOR) per 50 cell/μL increase 0.388; 95% CI 0.113–0.755; P=0.038, corresponding to a 60% reduction in the risk of IGT or DM] and lower HOMA-IR values (AOR for HOMA-IR≤2.82=0.001; 95% CI<0.001–0.070; P=0.035, corresponding to an approximately 99% reduction in the risk of IGT or DM) were associated with IGT or DM. Age (P=0.279), gender (P= 0.891), a previous AIDS diagnosis (P=0.059), previous Target Selective Inhibitor Library clinical trial use
of stavudine (P=0.061), family history of diabetes (P=0.713), waist circumference (P=0.182), coinfection with HBV (P= 0.375), and triglyceride (P=0.116), HDL-cholesterol (P= 0.608) and FPG levels (P=0.064) had no independent effect on IGT or DM as diagnosed using the OGTT. The second multivariable model confirmed HOMA-IR as an independent predictor of IGT or DM (AOR for HOMA-IR≤2.82=0.107; 95% CI 0.006–0.663; P=0.044, corresponding to an approximately 89% reduction oxyclozanide in the risk of IGT or DM), whereas low CD4 cell counts (P=0.069) and coinfection with HBV (P=0.375) were not independently associated with IGT or DM. Changes in glucose concentrations, insulin sensitivity and insulin secretion appear as early as 3–6 (and even up to 13) years before a diagnosis of DM is made . On the basis of the current guidelines, HIV-infected patients with a family history of diabetes, obesity or metabolic syndrome, or who are taking highly active antiretroviral therapy (HAART) (especially a PI-based regimen) should undergo a standard OGTT during the first visit to test for impaired glucose intolerance . The European AIDS Clinical Society guidelines (http://www.europeanaidsclinicalsociety.org/guidelines.