The prevalence of diabetes is higher among individuals infected with HIV than in the general population, according to a recent study
in BMJ Open Diabetes Research & Care
. These patients are also more likely than non-infected people to develop diabetes at a younger age and while not obese.
The researchers analyzed data from a survey of HIV patients in the United States and a health survey of the general American population. They gathered information on a number of other variables, including age, sex, race/ethnicity, poverty, and obesity. The HIV-infected respondents were also asked about their time since diagnosis, mean CD4 count, receipt of antiretroviral therapy, and disease stage.
The HIV-infected adults had an unadjusted diabetes prevalence of 10.3%, compared to 8.3% among the general population. After adjusting for differences in variable distribution, the prevalence of diabetes was 3.8 percentage points higher among the people with HIV.
The greatest disparities in diabetes prevalence between HIV-infected people and the general population were observed for people infected with hepatitis C virus, those with a high school education, and women. All of these groups had diabetes prevalence rates at least 5 percentage points higher for the HIV-infected group compared to their non-infected counterparts.
Among the HIV sample, diabetes was least common for those aged 20 to 44 years (6.7%) and most prevalent among people aged 60 years or older (19.6%) and obese people (18.9%). However, the comparison of adjusted prevalence rates suggests that people with HIV are still more likely than non-infected people to have diabetes at younger ages and in the absence of obesity.
Although some studies have shown a link between antiretroviral therapy (ART) and diabetes, the 2 were not found to be associated in this study. Similarly, CD4 count nadir was not associated with higher diabetes prevalence after adjusting for covariates. These results, according to the study authors, “highlight the need for more nuanced measures of chronic inflammation present in HIV infection and their interaction with traditional risk factors such as obesity.”
Clinical guidelines suggest that patients should be screened for diabetes indicators like glycated hemoglobin before beginning a course of ART, but the authors wondered if the guidelines should be revised in light of these findings. They also called for research into disease management strategies specifically tailored to people with HIV, citing studies that found weight loss and diabetes medications were less effective for this population.
“Given the large burden of [diabetes] among HIV-infected adults, additional research would help to determine whether [diabetes] screening guidelines should be modified to include HIV infection as a risk factor for [diabetes] and to identify optimal management strategies in this population,” they concluded.