Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. Hyperglycemia and insulin function in antiretroviral treatment-naive HIV patients in Ethiopia: a potential new entity of diabetes in HIV? Daniel Faurholt-Jepsen a,b , Mette F. Olsen b , Anna B. Andersen b , Pernille Kæstel b , Alemseged Abdissa c , Hiwot Amare d , Daniel Yilma c , Tsinuel Girma e , Markos Tesfaye f ,A ˚ se B. Andersen a , Henrik Friis b and Marit E. Jørgensen g,h Background: Although diabetes is more common in HIV patients, the direct link between HIV and diabetes is unknown. Glucose abnormalities should be assessed among antiretroviral treatment (ART)-naive patients to reduce confounding by ART. We assessed diabetes status, insulin function and association with inflammation among Ethiopian ART-naive HIV patients. Methods: Among HIV patients initiating ART, we used glycosylated hemoglobin (HbA1c) and oral glucose tolerance test (OGTT) to define prediabetes and diabetes. Insulin during OGTT was determined to calculate insulin function, and C-reactive protein and a1-acid glycoprotein were used as same-day markers of inflammation. Results: Among 332 HIV patients, mean (SD) age was 32.9 (8.8) years, and 222 (66.9%) were women. None had known diabetes, but we found diabetes prevalence using OGTT and HbA1c to be 7.6 and 8.5%, respectively. C-reactive protein and a1-acid glycoprotein were positively associated with hyperglycemia and insulin deficiency, but not insulin resistance. We found poor correlation between traditional risk factors (age and anthropometry) and diabetes, but participants generally had low BMI and waist circumference. Conclusion: ART-naive Ethiopian HIV patients had a high prevalence of prediabetes and diabetes, with a poor agreement between HbA1c and OGTT. Diabetes was associated with inflammation, but not with adiposity and age. Diabetes was linked to insulin deficiency, rather than insulin resistance, which may represent a different entity than type 1 and 2 diabetes. This has implications for choice of drugs, when managing diabetes in African HIV patients. Copyright ß 2019 Wolters Kluwer Health, Inc. All rights reserved. AIDS 2019, 33:1595–1602 Keywords: diabetes, glycosylated hemoglobin, HIV, insulin deficiency, insulin resistance, opportunistic infection a Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, b Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark, c Jimma University Specialized Hospital, d Department of Internal Medicine, e Department of Pediatrics and Child Health, f Department of Psychiatry, Jimma University, Jimma, Ethiopia, g Steno Diabetes Center, Gentofte, and h National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark. Correspondence to Daniel Faurholt-Jepsen, MD, PhD, Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark. Tel: +45 26 74 12 42; e-mail: daniel.faurholt-jepsen@regionh.dk Received: 23 January 2019; revised: 4 April 2019; accepted: 4 April 2019. DOI:10.1097/QAD.0000000000002249 ISSN 0269-9370 Copyright Q 2019 Wolters Kluwer Health, Inc. All rights reserved. 1595