Abstract
The Rio Grande Valley (RGV) in South Texas has one of the highest prevalence of obesity and type 2 diabetes (T2D) in the United States (US). We report for the first time the T2D prevalence in persons with HIV (PWH) in the RGV and the interrelationship between T2D, cardiometabolic risk factors, HIV-related indices, and antiretroviral therapies (ART). The PWH in this study received medical care at Valley AIDS Council (VAC) clinic sites located in Harlingen and McAllen, Texas. Henceforth, this cohort will be referred to as Valley AIDS Council Cohort (VACC). Cross-sectional analyses were conducted using retrospective data obtained from 1,827 registries. It included demographic and anthropometric variables, cardiometabolic traits, and HIV-related virological and immunological indices. For descriptive statistics, we used mean values of the quantitative variables from unbalanced visits across 20 months. Robust regression methods were used to determine the associations. For comparisons, we used cardiometabolic trait data obtained from HIV-uninfected San Antonio Mexican American Family Studies (SAMAFS; N = 2,498), and the Mexican American population in the National Health and Nutrition Examination Survey (HHANES; N = 5,989). The prevalence of T2D in VACC was 51% compared to 27% in SAMAFS and 19% in HHANES, respectively. The PWH with T2D in VACC were younger (4.7 years) and had lower BMI (BMI 2.43 units less) when compared to SAMAFS individuals. In contrast, VACC individuals had increased blood pressure and dyslipidemia. The increased T2D prevalence in VACC was independent of BMI. Within the VACC, ART was associated with viral load and CD4+ T cell counts but not with metabolic dysfunction. Notably, we found that individuals with any INSTI combination had higher T2D risk: OR 2.08 (95%CI 1.67, 2.6; p < 0.001). In summary, our results suggest that VACC individuals may develop T2D at younger ages independent of obesity. The high burden of T2D in these individuals necessitates rigorously designed longitudinal studies to draw potential causal inferences and develop better treatment regimens.
Highlights
Current antiretroviral therapies (ART) have dramatically improved the quality of life and increased the life span of persons with HIV (PWH)
We report for the first time the prevalence of type 2 diabetes (T2D) and its associated risk factors in PWH in the Rio Grande Valley (RGV), who are all enrolled at a single clinic, and contrast them with the HIVnegative Mexican Americans in the United States (US) and South Texas
We report the interrelationship between cardiometabolic risk factors, T2D risk, HIV viral load, various immunological parameters, and treatment regimens in this cohort
Summary
Current antiretroviral therapies (ART) have dramatically improved the quality of life and increased the life span of persons with HIV (PWH). When compared to the general population, PWH have an increased incidence of common ageassociated degenerative diseases, including metabolic disorders such as type 2 diabetes (T2D) and cardiovascular disease (CVD). Lorenzo et al compared the non-HIV infected Mexican American population with non-Hispanic whites, using Matsuda and insulinogenic indexes to assess insulin resistance. They showed that Mexican Americans have an odds ratio of 2.3 (95%CI 1.5, 3.34) for insulin resistance [2]. HIV-1 infected Hispanics are at an even greater risk of developing T2D and T2D-related complications. Few studies have systematically examined the incidence of these metabolic disorders in HIV-infected Hispanics, especially in the U.S.-Mexico border region who encounter unique socio-cultural, economic, migration-related challenges
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