With the advent of antiretroviral therapy (ART), HIV is becoming a common chronic illnesses, one that affects millions of people. In clinical practice, this has translated to a need to manage patients with comorbid HIV and type 2 diabetes mellitus (T2DM). Approximately 1 in 5 people with HIV also has prevalent T2DM, and control of glycated hemoglobin (HbA1c) levels in these patients may have a beneficial effect on CD4 counts. This is according to results of 2 studies presented at IDWeek 2019, held from October 2 to October 6, 2019, in Washington, DC.
To evaluate the overall prevalence of T2DM among people living with HIV in the United States, as well as among those in specific demographic subgroups, Birabaharan and colleagues1 conducted a cross-sectional study using data gathered from a database of 27 healthcare networks. Researchers included adult patients who had an active status between April 2014 and April 2019 whose records were not missing data on age, gender, race, and body mass index, and contained identifiers of HIV and T2DM.
Of the 90,900 patients identified as being infected with HIV, 21.1% also had T2DM; in comparison, this percentage in the general population is 14.9%. Analysis of subgroups of patients with HIV demonstrated that patients who were female (24.0%), aged ≥65 years (38.8%), obese (30.8%), had hypertension (37.7%), had hyperlipidemia (35.1%), were smokers (24.6%), or had a history of hepatitis C virus infection (29.5%) were more likely to have T2DM.
Further, patients with no history of receiving ART had higher prevalence of T2DM than those who did (24.9% vs 17.6%).
This relationship between T2DM and treatment of HIV was investigated by Powers-Happ, et al.2 This team used data from 554 patients in Washington, DC, who received care for HIV between 2011 and 2018 and conducted a longitudinal observational study to examine the effect of HbA1c level on CD4 count. Patients were categorized into 1 of 3 levels of HbA1c control (strict, moderate, uncontrolled), based on the most recent results available.
An unadjusted analysis demonstrated that patients with moderate or uncontrolled HbA1c (7.5%-9% and >9.0%, respectively) had higher mean CD4 counts compared with patients who had strict control (<7.5%). However, multivariate analysis showed that only moderate control of HbA1c had a significant difference in mean CD4 count compared with strict HbA1c (P =.02).
Researchers highlighted the importance of accounting for this window of glycemic control in development of future guidelines for ART in people living with HIV.
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
1. Birabaharan M, Strunk, A, Garg A, Hagmann S. Prevalence of type II diabetes mellitus among patients living with HIV in the United States. Presented at: IDWeek 2019; October 2-6, 2019; Washington, DC. Poster 340.
2. Powers Happ LJ, Monroe AK, Young HA, et al. The impact of glycemic control on CD4 cell count in persons living with HIV and diabetes mellitus—Washington DC. Presented at: IDWeek 2019; October 2-6, 2019; Washington, DC. Poster 342.