Leukocyte count and new-onset diabetes mellitus in people with HIV: A longitudinal study
Meyer SC and colleagues investigated the association of leukocyte count and new-onset diabetes mellitus in the SHCS using a matched case-control study design with incidence density sampling. The study benefits from an extensive observation period of more than 23 years and detailed documentation of clinical data within the regular SHCS follow-up.
The authors defined the date of diabetes mellitus diagnosis as matching date and matched cases and controls based on sex at birth, date of SHCS registration and age. For the present study, only leukocyte counts measured at the 6-monthly SHCS follow-up visits were considered. They compared the latest leukocyte counts before the matching date and leukocyte counts at years -2, -3, -5, -8, -9 and -10. Using uni- and multivariable conditional logistic regression, they estimated associations of different risk factors with diabetes mellitus. Risk factors included non-HIV related factors like body mass index (BMI) and smoking, and HIV-related risk factors including CD4 nadir, history of CDC stage C and type of ART, as well as Hepatitis C and cytomegalovirus seropositivity.
In total, 732 cases and 2032 matched controls with a leukocyte count, BMI and lipid levels measurements within 18 months prior to the matching date were included. Median age was 54 years, 79% were male at birth and the median observation period was around 12 years. As opposed to controls, cases had significantly higher leukocyte counts at the latest leukocyte measurement and up to 10 years prior to diabetes mellitus diagnosis. Participants in the highest leukocyte quintile had an almost 2.5-fold increased risk of developing diabetes mellitus compared to those in the lowest quintile.
In summary, the present study confirms the association of increased leukocyte counts with new-onset diabetes mellitus and highlights the contribution of chronic low-level inflammation to the development of diabetes mellitus in people with HIV. However, to determine the clinical value of leukocyte count monitoring for the prediction of diabetes mellitus, prospective studies are crucial.