The prevalence of diabetes among people infected with HIV is higher than in the general population, scientists have found out. The condition appears to develop at an earlier age in these patients, and even if they are not obese.
Diabetes is a chronic disease which affects around 422 million people around the world. Its burden on health systems is very important as it can cause a range of disabilities, from blindness, kidney failure, and heart attacks, to lower limb amputation. In 2012, the World Health Organisation estimates that 1.5 million people died as a direct result of diabetes.
In recent years, advances in HIV treatment have increased the life expectancy of those infected with the virus.
While this is a major advancement, it also means that these patients die more often from chronic metabolic disease like diabetes than in the past – rather than from AIDS-related complications.
Up to now however, the prevalence of diabetes among HIV-sufferers has not been well documented. Additionally, it is unclear if HIV-infected adults are at increased risk of developing the disease, and this question has been a source of controversy among researchers.
This study, published in the BMJ Open diabetes research and Care, sets out to find what the prevalence of the disease is among HIV-infected patients compared with the general population, and whether there needs to be changes in the way this group is cared for. It represents the first nationally representative estimate of diabetes burden among HIV-infected adults.
Younger and less obese
The scientists analysed data from a US nationally representative survey from the Medical Monitoring Project (with data from 8,610 HIV-infected adults) and from the National Health and Nutrition Examination Survey (5,604 adults from the general population). They calculated the prevalence of diabetes among these two groups.
The scientists found that the prevalence among HIV-infected adults was 10.3%. This was 3.8% higher than the prevalence in general population adults, after adjusting for age, sex, race/ethnicity, education, poverty-level, obesity, and hepatitis C infection. Among these HIV patients with diabetes, just under 4% had type 1 disease, 52% had type 2 and 44% had unspecified diabetes.
The data also suggests that HIV-infected persons may be more likely to develop the disease at younger ages than people who don't have HIV. They are also more at risk of having type 2 diabetes in the absence of obesity than the general population. Nevertheless, both increasing age and obesity were found to increase the prevalence diabetes among HIV-infected individual.
This research does not on its own conclude whether HIV is a risk factor for diabetes, but given the large burden of the disease among HIV-infected adults, more research should be conducted in the future on the topic.
Traditional strategies to improve insulin sensitivity such as weight loss and diabetic medical therapy have previously been shown to be less effective among HIV-infected individuals. This study confirms the urgent need to come up with improved diagnosis, monitoring and diabetes management strategies for this vulnerable population.