Transcript pres_odell - Harlem Children Society

Epidemiology
Impaired Glucose Tolerance in
HIV-Infected Drug Users
By: Odell Aaron La Croix
Work Site:Department of Epidemiology
Mentor: Dr. Andrea Howard
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
Hypotheses
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.
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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.
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
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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
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Personnel
There are several essential personnel that
help keep this study running successfully.
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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 HIVinfected women. By Dr. Andrea Howard.
Acknowledgements
Dr. Andrea Howard
Montefiore Medical Hospital
Dr Sat Bhattacharya
Epidemiology Clinic Staff
Harlem Children Society