Comorbid HIV and Diabetes: Double Challenge

Antiretroviral therapy (ART) extends patient lifespan and converts HIV to a chronic condition. In light of this, HIV patients must focus on chronic conditions affecting their long-term survival and quality of life.

HIV-infected patients are 4 times more likely to develop type 2 diabetes than uninfected individuals. Both HIV and diabetes increase vascular disease and suppress the immune system. Protease inhibitor-based HIV therapy causes insulin resistance and increases the risk of diabetes development.

An article published ahead-of-print in AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV indicates that less than half of diabetic HIV-infected patients have optimal control of both diseases.

This retrospective study enrolled 186 patients with diabetes from a large, urban Ryan White-funded HIV clinic. Participants were at least 25 years old, had comorbid HIV and diabetes, and had received ART for 6 months or more. The researchers defined optimal control as an undetectable viral load and a HbA1C value of 7% or less.

Older patients, those taking something other than insulin-based therapy, and white or Hispanic patients were most likely to have optimal control. Patients with suboptimal HIV control were more likely receiving insulin therapy and African-American. Younger patients had poorer diabetes control.

Patients older than 50 years were more likely to be adherent to both HIV and diabetes medications. Meanwhile, those who had undetectable viral loads had significantly lower mean HbA1C than those whose viral loads were detectable.

Overall, HIV control was more common than diabetes control. Patients with good HIV control were less likely to be receiving protease-inhibitor based ART.

The HIV clinic setting focuses on extensive HIV education and counseling, but its providers have less diabetes expertise. A minority of enrolled urban HIV clinic patients successfully controlled both their HIV and diabetes.

Providers should target young, insulin-receiving, and African American HIV-infected patients with diabetes for further assistance with disease management.