Abstract
BackgroundDiabetes mellitus (DM) is a major and increasing public health problem that may be underdiagnosed and undertreated among persons living with HIV (PLWH).ObjectiveTo describe the diagnosis, treatment and follow-up of DM among PLWH.MethodsThis study was performed inside a monocentric cohort of 1494 PLWH. DM was defined as having a FG ≥126 mg/dL twice or a HbA1c ≥6.5%, or a history of diabetes, or receiving antidiabetic treatment. The first visit mentioning a diagnosis of DM was considered as the baseline visit. Chi-Square or Fisher exact test were used to examine the association between categorical variables and DM, Wilcoxon or Student t-test were used for continuous variables.Results156 PLWH with DM were included. Compared to non-diabetic participants, they were more likely to be native of Sub Saharan Africa (31.6% vs. 22.4%, p = 0.027) and older (54.6 vs. 49.9 years, p<0.001), to have a higher BMI (> 25 for 46.1% vs. 35.3%, p = 0.020) and a poorer control of HIV (HIV RNA<50 copies/mL: 80.1% vs. 89.5%, p<0.001). The diagnosis of DM was missed in 37.8% of PLWH, and 47.2% of PLWH treated for DM did not reach a HbA1c<7%. PLWH with DM were more frequently on antihypertensive and/or lipid-lowering medications: 94.2% had a LDL-cholesterol <70 mg/dL and 60.9% had a blood pressure <140/90 mmHg.ConclusionIn a setting of HIV-control, HIV care providers should focus on metabolic issues. The management of DM and associated risk factors is mandatory to prevent cardiovascular disease in PLWH.
Highlights
Diabetes mellitus (DM) is a major public health problem with a worldwide prevalence of 8.5% according to WHO’s (World Health Organization) last report that is expected to increase in the decades [1]
Compared to non-diabetic participants, they were more likely to be native of Sub Saharan Africa (31.6% vs. 22.4%, p = 0.027) and older (54.6 vs. 49.9 years, p 25 for 46.1% vs. 35.3%, p = 0.020) and a poorer control of HIV (HIV RNA
The diagnosis of DM was missed in 37.8% of People living with HIV (PLWH), and 47.2% of PLWH treated for DM did not reach a HbA1c
Summary
Diabetes mellitus (DM) is a major public health problem with a worldwide prevalence of 8.5% according to WHO’s (World Health Organization) last report that is expected to increase in the decades [1]. Specific HIV-related risk factors may contribute to the increased prevalence of DM in PLWH, including cumulative ART exposure [9], use of ‘metabolically unfriendly’ antiretroviral drugs such as first-generation protease inhibitors and nucleoside analogues [10,11,12], lipodystrophy, as well as prolonged HIV exposure duration, low CD4 nadir [7] and persistent inflammation [3,6,8]. Diabetes mellitus (DM) is a major and increasing public health problem that may be underdiagnosed and undertreated among persons living with HIV (PLWH)
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