CATIE News - Diabetes monitoring may be needed for women who use opiates or have hepatitis C
2010 May 28 - Several reports have suggested that some HIV-positive people may be at increased risk for developing diabetes. As part of a project
to try to understand this issue, researchers in the United States reviewed experiments on animals and HIV-negative people and found a link between exposure to opiates,
including heroin and related substances, and diabetes. So the researchers decided to review their database to assess the possibility of any links between use of
opiates and the development of diabetes in women with HIV or at high risk for HIV infection. Their findings suggest that the use of opiates, with or without
hepatitis C virus infection, is associated with the development of diabetes. However, some caution is needed when interpreting the results from this study.
Study details
The research team was associated with a large data set called the Women's Interagency HIV Study (WIHS). This data set has recruited 2,793 HIV-positive women and 975
women at high risk for HIV infection since 1994.
Once enrolled, participants visited their study site twice a year, where they were interviewed, had a physical exam and had blood drawn for analysis. Starting in 2000, the
WIHS team began to assess fasting blood sugar levels.
The WIHS team did not provide an average profile of its participants, most of whom were recruited from low-income neighbourhoods in cities across the U.S.
Results-Substance use
In analysing their database the researchers found that 464 women disclosed that they had used opiates before entering WIHS. Among these women, patterns of opiate usage were as follows:
heroin or illicit methadone
prescribed methadone
illicit opiates and prescribed methadone
Results-Diabetes at the start of the study
Upon entering the study, 11% of women had diabetes. The researchers found that women who previously used opiates (18%) were more likely to have diabetes than women
who never used opiates (9%).
Results-Subsequent cases of diabetes
Researchers monitored 2,016 women who entered the study and did not have diabetes. On average they were monitored for 3.5 years. The risk of diabetes in this group of women
increased because of the following:
use of opiates in the past or present
having hepatitis C infection (with or without HIV co-infection)
The research team noted that women who had hepatitis C (regardless of whether they were co-infected with HIV) and who were currently using opiates had the greatest chance
of developing diabetes.
What the researchers called "classic diabetes risk factors"-older age, having a body mass index (BMI) greater than 30 (in other words, being obese) and having a
family history of diabetes-also predicted which participants would get diabetes in WIHS. However, even taking these factors into account, current use of opiates was
still associated with an increased risk for diabetes.
Exposure to anti-HIV drugs was not associated with the development of diabetes.
Why is caution needed?
The present WIHS study design is that of a cohort study. Such studies are very good at finding associations-in this case, between the use of a certain group of drugs
and developing diabetes. However, cohort studies by their nature can only find associations, they cannot prove cause and effect. That is, they cannot prove that
taking a particular drug (opiate) will indeed cause a particular effect (diabetes).
Furthermore, confounding or channeling bias is a problem that affects cohort studies and makes drawing firm conclusions difficult when interpreting the data. However,
the results of the WIHS study are still useful because they can form a foundation for ideas that could be explored in studies of a more robust design. Perhaps such
studies will also explore possible links between opiates and blood sugar problems in males.
In the meantime, people who are prescribed methadone should not stop using this drug because of the WIHS findings. Indeed, the WIHS researchers suggest that doctors
who care for women with or at risk for HIV infection and who also use opiates may wish to regularly monitor their patients' blood sugar levels.
- Sean R. Hosein
REFERENCES:
1. Howard AA, Hoover DR, Anastos K, et al. The effects of opiate use and hepatitis C virus infection on risk of diabetes mellitus in the Women's
Interagency HIV Study. Journal of Acquired Immune Deficiency Syndromes. 2010; in press.
2. Aberg JA, Ribaudo H. Cardiac risk: not so simple. Journal of Infectious Diseases. 2010 Feb 1;201(3):315-7.
3. Gutstein HB and Akil H. Opioid analgesics. In: Brunton LL, Lazo JS and Parker KL. The Pharmacological Basis of Therapeutics. Eleventh ed.
New York: McGraw-Hill Companies; 2006. p. 547-590.
4. O'Brien CP. Drug addiction and drug abuse. In: Brunton LL, Lazo JS and Parker KL. The Pharmacological Basis of Therapeutics. Eleventh ed.
New York: McGraw-Hill Companies; 2006. p.607-627.
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CATIE-News is written by Sean Hosein, with the collaboration of other members of the Canadian AIDS Treatment Information Exchange, in Toronto.
From Canadian AIDS Treatment Information Exchange (CATIE). For more information visit CATIE's Information Network at http://www.catie.ca
Source: CATIE: CANADIAN AIDS TREATMENT INFORMATION EXCHANGE
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