Abstract
Treated human immunodeficiency virus (HIV) infection is associated with high rates of type 2 diabetes mellitus (DM), metabolic syndrome and central obesity/body fat partitioning disorders. To our knowledge, there are no available data comparing diabetes care in people with both HIV+DM vs. DM alone (DM-controls) within the same service and evaluating if benchmarked standards of care are being met in people with HIV+DM. This study evaluated the frequency that people with HIV+DM met the benchmarked American Diabetes Association (ADA) standards of care in diabetes (targets for HbA1c, blood pressure, lipid levels, complication screening, and healthy weight), compared to age- and sex- matched controls with diabetes, in an urban teaching hospital. The frequency of diabetes complications and rates of obesity and metabolic syndrome were also examined. All participants were male; individuals with HIV+DM (n = 30) were similar to DM-controls (n = 30) for age, diabetes duration and smoking status, but were more frequently non-obese compared to DM controls (92 vs. 55%, respectively, p = 0.003). Only 41% of HIV+DM met HbA1c targets, compared with 70% of DM-controls (p = 0.037). Blood pressure targets were poorly met in both HIV+DM and DM-controls: 43 vs. 23%, respectively (p = 0.12); LDL cholesterol targets were met in 65 vs. 67% (p = 1.0). Benchmarked complication screening rates were similar between HIV+DM vs. DM-controls for annual foot examination (53 vs. 67%, respectively, p = 0.29); biennial retinal examination (83 vs. 77%, respectively, p = 0.52); and annual urinary albumin measurement (77 vs. 67%, respectively, p = 0.39). The prevalence of diabetes complications was similar between HIV+DM compared to DM-controls: macrovascular complications were present in 23% in both groups (p = 1.0); the prevalence of microvascular complications was 40 vs. 30%, respectively (p = 0.51). Achieving the standard of care benchmarks for diabetes in people with both HIV-infection and diabetes is of particular importance to mitigate against the accelerated cardiometabolic outcomes observed in those with treated HIV infection. HIV+DM were less likely to achieve HbA1c targets than people with diabetes, but without HIV. People with HIV+DM may require specific strategies to ensure care benchmarks are met.
Highlights
According to the latest United Nations acquired immunodeficiency syndrome (AIDS) HIV data, there are currently 36.7 million people globally living with human immunodeficiency virus (HIV)-infection, with 19.5 million receiving combined anti-retroviral therapy [1]
Our single center retrospective study found that people with both HIV-infection and diabetes met the benchmarked standards of care for individualized HbA1c far less frequently compared to those with diabetes without HIV
According to the 2013 American Diabetes Association (ADA) guidelines that remain current and in clinical practice, the target HbA1c should be based on duration of diabetes, age/life expectancy, known cardiovascular disease, advanced micro-vascular complications, hypoglycaemic unawareness or comorbid conditions [8]
Summary
According to the latest United Nations AIDS HIV data, there are currently 36.7 million people globally living with human immunodeficiency virus (HIV)-infection, with 19.5 million receiving combined anti-retroviral therapy (cART) [1]. Advances in infectious disease detection and cART have increased life expectancy in people living with HIV-infection and acquired immunodeficiency syndrome (AIDS), with substantial diminution in the frequency of AIDS-related complications and deaths [2,3,4,5,6]. There has been a rise in agerelated conditions in this group, cART-associated metabolic complications such as type 2 diabetes mellitus (DM) and cardiovascular disease, which are major contributors to the increased morbidity and mortality associated with treated HIV-infection [2,3,4, 6]. Risk factors include the global epidemic of obesity, superimposed on traditional risk factors such as family history, medications (including corticosteroids and combined antiretroviral therapy) and hepatitis C virus (HCV) infection [2]
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