Diabetes is a disease all too familiar in the United States. Those who are of older age, have family history of the disease, and are overweight are at high risk of developing either Type 1 or Type 2 diabetes at some point in their lifetime. One risk factor that is not spoken on is the risk HIV positive persons being more likely to have Type 2 diabetes.
Statistics released by the U.S Department of Health and Human Services ("HHS") recommend those living with HIV should have blood glucose levels checked before starting treatment with HIV medications, as some may need to avoid certain medications if they have higher blood glucose levels.
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While people living with HIV/AIDS are at a higher risk of developing Type 2 diabetes, it can be prevented and managed properly. HHS recommends maintaining a healthy weight, eating healthy and adding physical activity to one’s daily routine. However, for HIV-positive patients who already have diabetes, finding proper medications for HIV that work alongside diabetes medication can be difficult.
“As antiretroviral therapy is now recommended for all patients regardless of CD4 T lymphocyte (CD4) cell count, and because therapy must be continued indefinitely, the focus of patient management has evolved from identifying and managing early antiretroviral-related toxicities to individualizing therapy to avoid long-term adverse effects, including diabetes and other metabolic complications, atherosclerotic cardiovascular disease, kidney dysfunction, bone loss, and weight gain,” HSS said on its website.
Predisposed conditions also put individuals at risk of adverse effects of ARV medications for HIV: these include underlying liver disease, viral hepatitis, psychiatric disorders and genetic factors. Finding an effective regimen for HIV that works alongside other medications is a tricky business, according to the HHS.
“Switching a patient from an effective ARV agent or regimen to a new agent or regimen must be done carefully and only when the potential benefits of the change outweigh the potential risks of altering treatment. The fundamental principle of regimen switching is to maintain viral suppression,” HHS said. (HHS, 2019)
In 2018, a cross sectional study looking at people living with HIV/AIDS in London was held to determine prevalence and risk factors for type two diabetes. Alastair Duncan and his colleagues discovered that the prevalence of Type 2 diabetes was alarmingly high. One in three patients had pre-diabetes or Type 2 diabetes. (Duncan, A., Goff, L., & Peters, B.)
“The duration of HIV infection, ARV treatment and particularly the use of metabolically toxic ARVs, weight gain following initiation of ARVs, and the presence of lipodystrophy are all significantly associated with an increased risk of dysglycaemia,” Duncan said.
This high prevalence of Type 2 diabetes in HIV-positive patients requires improved screening targeted to older patients, according to Duncan’s study. Antiretrovirals cause weight gain, which can in turn greatly increase the chance of developing Type 2 diabetes. (NIH, 2019).
People living with HIV/AIDS who are concerned about the chance of developing diabetes should speak to their primary care provider about solutions and new medications to look at.
References:
- Duncan, A., Goff, L., & Peters, B. (2018, March 12). Type 2 diabetes prevalence and its risk factors in HIV: A cross-sectional study. Retrieved July 29, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5847234/
- Adverse Effects of ARV Limitations to Treatment Safety and Efficacy Adult and Adolescent ARV. (2019, December 18). Retrieved July 29, 2020, from https://aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-arv-guidelines/31/adverse-effects-of-arv
- HIV and Diabetes Understanding HIV/AIDS. (2019, October 18). Retrieved July 29, 2020, from https://aidsinfo.nih.gov/understanding-hiv-aids/fact-sheets/22/59/hiv-and-diabetes
Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.
From Jules Levin, Executive Director of the National AIDS Treatment Advocacy Project (NATAP):
ReplyDeleteDiabetes in HIV is a well recognized problem among many including clinicians. Recent data shows diabetes increasing among the HIV aging population & doubling in recent yeas from earlier. Associated with this is likely the increasing occurrence as PLWH age for fatty liver which is associated with diabetes & for non-viral hepatitis, which is a liver disease in those who never had HBV or HCV. There is cross-over between fatty liver disease (fat accumulation in the liver) & non viral hepatitis meaning that when researchers say fatty liver prevalence among PLWH may be 35% & non viral hepatitis my be 30% we are not sure which is causing the hepatitis or liver disease. Speaking to your doctor about this is the way to address this. The fibroscan test can be used to measure fatty liver disease, but starting a conversation as one gets with your doctor is the way to start. Many PLWH >50 do NOT know HIV causes increased risk for comorbidities & diabetes. The increased risk for co-Morbidities & diabetes for aging HIV+ being one of them is known by many HIV+ but there are many PLWH who are aging, >40, >50 who have no idea about the aging/HIV syndrome, that HIV causes premature onset for comorbidities, that HIV+ have greater numbers of comorbidities, as PLWH age past 55 the numbers of comorbidities increase & the diabetes risk is increased & increases with age & for some PLWH may be as much as doubled. Inordinate weight gain can pre-dispose one to increased risk for diabetes & cardiovascular disease, fatty liver & NASH- liver disease, cognitive impairment and more.
Type 2 diabetes prevalence [doubled] and its risk factors in HIV: A cross-sectional study (https://www.natap.org/2019/HIV/052819_03.htm)
T2D prevalence was 15.1% in 2015 with a relative risk of 2.4 compared to the general population. The prevalence compared to 6.8% ten years earlier. The 2015 versus the 2005 cohort was significantly older (median age 49 (42-57) years versus 41 (IQR 35-47), p<0.001), had a higher BMI (27.4 (23.3-29.9) versus 24.9 (22.4-28.0) kg/m2 respectively, p = 0.019) and hypertensive (37.9% versus 19.6 respectively, p<0.001). The strongest predictors of dysglycaemia in the 2015 cohort were hepatic steatosis and hypertension, odds ratios (OR) and 95% confidence intervals (CI) 6.74 (3.48-13.03) and 2.92 (1.66-5.16) respectively, and also HIV-related factors of weight gain following antiretroviral initiation and longer known duration of HIV infection (OR 1.07 (1.04-1.11) and 1.06 (1.02-1.10) respectively).
Conclusions
The alarmingly high prevalence of T2D in HIV requires improved screening, targeted to older patients and those with a longer duration of exposure to antiretrovirals. Effective diabetes prevention and management strategies are needed urgently to reduce this risk; such interventions should target both conventional risk factors, such as abdominal obesity, and HIV-specific risk factors such as weight gain following initiation of antiretrovirals.