Epidemiology

Impaired Glucose Tolerance in HIV-Infected Drug Users

By: Odell Aaron La Croix

Mentor: Dr. Andrea Howard

Work Site:Department of Epidemiology

What Is Epidemiology?

Is the study of how disease is distributed in populations. Also the “Factors” that influence or determine the distribution.The major purpose of epidemiology is to provide a clue to the changes that take place over time.

The Objectives of Epidemiology

We must identify the etiology.

Etiology: the set of factors that contributes to the occurrence of a disease.

Determine the extent of disease found in the community.

Study the natural history and prognosis of the disease.

Evaluate both existing and new preventative and therapeutic measures of caring for subjects.

Find the most effective form of primary prevention.

Study Aim

The Aim of this study is to determine the impact of HIV infection, PI therapy and HCV infection on the incidence of IGT and type 2 Diabetes.This study addresses confirm/refute three main hypotheses. PI therapy will be associated with the development of

IGT and type 2 Diabetes In individuals with IGT PI will be associated with the

development of Diabetes. HCV infection will be associated with the development

of IGT and type 2 diabetes.

Hypotheses

Impaired Glucose Tolerance /Diabetes

What is it?IGT or Impaired Glucose Tolerance is when the subject has an elevated blood glucose (sugar) level but not yet high enough to be called diabetes but is considered pre-diabetes.

Diabetes Mellitus: Is a relative or absolute lack of insulin leading to uncontrolled carbohydrate metabolism in adult onset diabetes there seems to be an association with obesity.

Certain predetermined characteristics of a person make a person more or less susceptible to IGT or Diabetes.

Ex. Race, Age, Genetic History.

HAART /PIsHAART(Highly Active Antiretroviral Therapy) Is a “cocktail” of different medicines that are used to treat HIV because each medicine has a different way of fighting the virus. The most well known are Nucleotide Reverse Transcriptase Inhibitors,  Non Nucleoside Reverse Transcriptase Inhibitors, Fusion Inhibitors and Protease InhibitorsPi’s (Protease Inhibitors) Are a family of medicines that help treat the HIV virus they are incorporated with HAART. There is evidence that PI’s may decrease glucose tolerance.

Ex. Amprenavir, Indinavir , Saquinavir

Oral Glucose ToleranceTest

An OGTT is used to diagnose asymptomatic abnormalities in glucose clearance.

Subject must “Fast” and blood will be taken. The Subject will be given 75g of Glucose. Blood will be taken 30 mins after drink was administered. Blood will be taken 120 (2hrs) after drink was

administered. The results of the test will be compared to a specific

guideline created to measure the extent of glucose tolerance.

The Subjects

There Two hundred and twenty nine adult women already involved in Ms. (A Natural Study of Menopause in HIV infected women) and Two Hundred and fifteen adult men also involved in the CHAMPS(Study on older men). 266 of the total patients are HIV infected 170 are on HAART with PI 62 are on HAART but PI “Naïve” 65 HAART Naïve Anything involving any personal patient information

is transmitted on strictly confedential.(ID number)

Steps

There are scheduled Semiannual visits for each patients.

Each visit there are a few things that are always repeated. InterviewBloodPhysical exam

Materials

ACASI’s

Clinical Equipment

Phlebotomist Instruments

Computers and Intranet Servers

Standardized Interview

Face to Face

Audio Computer Assisted Self Interview Sociodemographic Medical History HAART Drug and Alcohol Use Family History

The object of interviewing the patient various times

Personnel

There are several essential personnel that help keep this study running successfully. Principal Investigators (originators,Grants) Data Managers Study Coordinators Interviewer Phlebotomists Receptionists

Conclusions

The study is ongoing so the results are still pending.

There is a definite link to behavior and lifestyle with IGT susceptibility.

References

Epidemiology 3rd Edition by Leon Gordis

HIV and Aids Sherris Microbiology 4th Edition

Lauer GM and Walker BD Hepatitis C virus infection N England Medical Journal

Association of Hepatitis Infection and Antiretretroviral use with Diabetes Mellitus in drug users By DR. Andrea Howard

Disorders of Glucose Metabolism among HIV- infected women. By Dr. Andrea Howard.

Acknowledgements

Dr. Andrea Howard

Montefiore Medical Hospital

Dr Sat Bhattacharya

Epidemiology Clinic Staff

Harlem Children Society