Highly Active Antiretroviral Therapy in Adult HIV-Infected Patients with Diabetes Mellitus: A 5-year Prospective Cohort Study

Abstract

Adverse effects following long-term use of highly active antiretroviral therapy (HAART), such as metabolic syndromes (MetS) and cardiovascular diseases (CVDs), have been reported. We determined whether patients with controlled pre-existing diabetes mellitus (DM) undergoing HAART are at high risk of long-term adverse effects, compared with HIV-infected patients without DM. In this prospective cohort study that recruited 172 HIV-infected patients, patients were followed up every six months for five years. Data Collection on Adverse Effects of Anti-HIV Drugs (D:A:D), a CVD risk score for HAART, and lab data, were compared between patients with controlled DM and non-DM patients matched on age and gender. HAART was less effective for HIV-infected patients with DM, with a higher plasma HIV RNA load in plasma viral load (PVL) testing (r=0.4868, P=0.0216) since the third year of follow-up. HAART increased the risk of CVDs for DM patients, with higher D:A:D (R) (r=0.1636, P=0.0336) and D:A:D (F) (r=0.1883, P=0.0142) scores at fifth year. DM patients presented with higher risk of advanced stages CKD (GFR<30 mL/min) (r=0.3226, P< 0.0001), with increased creatinine (r=0.5669, P<0.0001) and BUN (r=0.2832, P=0.0009). As of MetS, DM patients had increased waist circumference (r=0.2601, P=0.0006), total cholesterol (CHO) (r=0.2745, P=0.0309), LDL (r=0.1925, P=0.0402), compared to baseline. Even though under controlled status at baseline, DM patients still had higher fasting blood sugar since the third year (r=0.3129, P=0.0002). In conclusion, HAART was less effective in DM patients, and resulted in more subsequent CVDs and renal toxicities; other signs of metabolic syndromes were as well observed.