Rising Incidence of Diabetes in Adults With HIV on Antiretroviral Therapy

HIV red blood cells
HIV red blood cells
More research is needed to better capture the interplay between prediabetes/diabetes and antiretroviral therapy in people with HIV.

The burden of diabetes and prediabetes is rapidly increasing in people living with HIV on antiretroviral therapy (ART), according to research published in Epidemiology

The use of ART in patients with HIV has led to a significant drop in AIDS-related opportunistic infections, but long-term ART use is associated with numerous mitochondrial toxicity-related complications. Therefore, age-related comorbidities and diseases like diabetes appear to be an emerging threat in this population.

A meta-analysis of 44 studies published between January 2000 and April 2017 was used to estimate the incidence of diabetes and prediabetes in ART-exposed people with HIV. The pooled incidence rates for diabetes and prediabetes were 13.7 per 1000 person-years of follow-up (95% CI, 13-20; I² = 98.1%) in 396,496 person-years and 125 per 1000 person-years (95% CI, 0-123; I² = 99.4) in 1532 person-years, respectively. The risk factors for diabetes were largely the same as those for the general population except for cumulative exposure to some ART treatments, but this finding was inconsistent between studies.

Several limitations were noted, mainly the existence of “substantial heterogeneity in incidence estimates, which was not completely explained by study-level characteristics investigated.” Sources of this heterogeneity were not investigated due to limited descriptions of methods in the published works. It is also possible that future estimates of incidence will be lower due to the availability of new ART drugs with less metabolic impact.

Investigators, however, conclude that the data shows “the important and fast-increasing burden of diabetes…and prediabetes among the ART-exposed HIV-infected population,” and this reinforces “the thesis of a current double burden of infectious and non-communicable diseases.” Further, “policy makers should be aware of this risk, in order to better prepare health systems for proper management of this growing diabetes…population, which may experience pharmacologic interactions between antidiabetic drugs and ART.”

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Nansseu JR, Bigna JJ, Kaze AD, Noubiap JJ. Incidence and risk factors for prediabetes and diabetes mellitus among HIV infected adults on antiretroviral therapy: systematic review and meta-analysis [published online February 1, 2018]. Epidemiology. doi:10.1097/EDE.0000000000000815