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 /PIs HAART(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 Inhibitors Pi’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 Tolerance Test 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. Interview Blood Physical 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 3 rd Edition by Leon Gordis HIV and Aids Sherris Microbiology 4 th 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 Children SocietySociety