Diabetes Prevalence High in HIV-Infected Adults in US

Pam Harrison

February 01, 2017

The prevalence of diabetes is higher among HIV-infected individuals living in the United States compared with the general adult US population, and it is more likely to occur both in younger adults and in the nonobese than in non-HIV controls, the first estimate of its kind indicates.

"Nationally representative estimates of diabetes mellitus prevalence among HIV-infected adults in the US are lacking," lead author Alfonso Hernandez-Romieu, Rollins School of Public Health, Emory University, Atlanta, Georgia, and colleagues observe in their study, published online January 30 in BMJ Open Diabetes Research & Care.

"This analysis...suggests that HIV-infected adults may be more likely to have diabetes mellitus at younger ages and in the absence of obesity compared with the general US adult population," they observe.

Hence, they recommend that healthcare providers should follow existing screening guidelines and obtain fasting blood glucose and HbA1c prior to and after starting antiretroviral therapy.

More Than One in 10 With HIV Infection Also Has Diabetes

The investigators relied on data from the Medical Monitoring Project (MMP), a survey conducted between 2009 and 2010 involving a total of 8610 HIV-infected adults. The objective of the MMP is to document behavioral and clinical features of HIV-infected adults under medical care in the United States to arrive at a national picture of how HIV affects adults there.

Data from this survey were compared with that from 5604 adults who participated in the annual National Health and Nutrition Survey (NHANES) 2009–2010.

The demographics of both cohorts were relatively well matched. Close to three-quarters of MMP participants were male, as were almost half of those from NHANES. Almost 60% of HIV-infected participants were at least 45 years of age or older, as were 51% of their NHANES counterparts. And over half of the MMP cohort, at 52%, had more than a high school education, and 56.5% were living above the poverty line.

Among NHANES participants, a slightly higher percentage, at 58.7%, had more than a high school education and significantly more, at 91.5%, were living above the poverty line.

In contrast, just 25% of MMP participants had a body mass index (BMI) of 30 kg/m2 or greater compared with 36% of NHANES participants, and far more HIV-infected adults were also coinfected with hepatitis C (HCV), at close to 21%, compared with under 2% of the general population.

Nearly all patients in the HIV-infected cohort had received some form of antiretroviral (ART) therapy within the past year.

Overall, results showed that more than one in 10 HIV-infected adults at an adjusted prevalence of 11.8% had diabetes compared with an adjusted prevalence of 8% in the general population.

Among HIV-infected individuals with diabetes, 4% had type 1 diabetes, 52% had type 2 diabetes, and among the remaining 44%, the type of diabetes was unspecified.

After adjustment for differences in distributions of sex, age, race/ethnicity, education, poverty, obesity, and HCV infection prevalence, "diabetes prevalence was 3.8% higher in HIV-infected adults compared with general population adults," Dr Hernandez-Romieu and colleagues report.

Larger differences in the adjusted prevalence of diabetes between various subgroups of patients with HIV were also observed.

Adjusted Prevalence Difference of Diabetes in HIV-infected Subgroups vs General US Adult Population

  HIV-infected adults (%) General US adult population (%) Difference in prevalence of diabetes in HIV-infected cohort vs general population (%) P
Total 11.8 8.0 3.8 0.0002
Coinfection with HCV 13.4 7.1 6.3 0.02
High school or equivalent education 11.4 6.3 5.1 0.0001
HIV-infected women 12.4 7.4 5.0 0.0003
Non-Hispanic whites 11.4 6.5 4.9 <0.0001
Non-Hispanic blacks 13.1 11.8 1.3 0.4
Hispanic or Latino 13.1 11.4 1.6 0.4
Below the poverty line 11.8 7.2 4.6 0.002
Obese 18.1 13.7 4.4 0.003
Younger adults (20 to 44) 6.4 2.3 4.1 <0.0001

Should HIV Infection Be a Risk Factor for Diabetes?

"We observed a strong association between both increasing age and obesity and prevalent diabetes mellitus among HIV-infected individuals, suggesting that these traditional risk factors play a major role in the development of diabetes among HIV-infected adults," Dr Hernandez-Romieu and coauthors state.

On the other hand, HIV-specific factors seemed to also increase the risk of diabetes among the HIV-infected cohort. For example, the geometric mean CD4 count in the past 12 months — though not the CD4 count nadir — was associated with an increasing risk of diabetes: the higher the CD4+ cell count, the greater the risk of diabetes.

Furthermore, women infected with HIV were more likely than their general US counterparts to have diabetes, and this effect was independent of obesity, the investigators add.

"Our findings [also] indicate that HIV may compound the deleterious effects of HCV, putting HIV/HCV coinfected individuals at even higher risk of diabetes mellitus," the study authors observe.

This finding is highly relevant, given the highly effective anti-HCV drugs available today, which offer a potential cure for HCV-infected patients and thus could potentially reduce the risk of diabetes in patients coinfected with HIV and HCV, they note.

In conclusion, they recommend, "HIV-care providers should follow existing diabetes mellitus screening guidelines, which recommend [fasting blood glucose] and HbA1c be obtained prior to and after starting antiretroviral therapy.

"[And] given the large burden of diabetes mellitus 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."

None of the authors had any relevant financial relationships.

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BMJ Open Diabetes Res Care. Published online January 30, 2017. Article

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