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Aging & Diabetes - Is diabetes prevalence higher among HIV-infected individuals compared with the general population? Evidence from MMP and NHANES 2009-2010 - YES
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Aging & Diabetes: Clearly although overlooked as a serious aging related comorbidity is diabetes, it is a serious concern. Cognitive impairment & neurologic disease, bone disease, heart disease, cancers, kidney disease get most of the attention, but diabetes is a significant problem with rates at around 20% in this study for HIV+ over 60, but I think these rates are likely to increase and perhaps even more important is that with aging the quality of the diabetes will worsen among some HIV+ with sugar becoming more difficult to control, along with worsening CVD function & kidney functioning worsening I think we will see worsening of diabetes complications & it will be harder for patients to manage.
CORRECTION - From Jules: you can see below in Table 3 the uniqueness of diabetes in HIV: (1) at younger ages prevalence is higher among HIV+ vs general population suggesting diabetes develops earlier among HIV+ and among those over 60 years old prevalence is 22% in HIV+ ; (2) among non obese prevalence is higher among HIV+ vs the general population 8.1% vs 5.14%; (3) of note prevalence is higher among HIV+ women vs HIV men while among HIV-negative prevalence is higher among men, suggesting this is because African American and Latino women are significant in numbers and a high percent and their weight tends to be higher; (4) among whites the diabetes prevalence is much higher (12%) among HIV+ vs general population (9.38%); HCV has an inordinate affect on diabetes among HIV+ with 14% prevalence who are HCV+HIV infected vs 8.22% among HIV-negatives. The worse affect of diabetes is due in part to greater inflammation among HIV+; its due in part to early use of d4T & ddI; its due in part to lipoatrophy & lipodystrophy; its a due in part to greater insulin resistance among HIV+, in the early days indinavir was associated with increased glucose in blood. Lipoatrophy & lipodystrophy has NOT gone away, the rates are lower but now even with newer ARTs these body changes continue to occur but at lower rates perhaps. In ACTG 5260 reported at CROI in 2015 6% to 8% of patients on newer ARTs had >20% limb fat loss and 16% to 18% had greater than 10% limb fat loss. VAT, belly fat, increase was experienced by 30% of these patients and viral load at baseline over 100,000 caused increases in fat changes, showing that HIV itself causes body fat changes.......
LATEST UPDATE ON HIV LIPODYSTROPHY: Interview with Dr Grace McComsey
Body composition changes after initiation of raltegravir or protease inhibitors. CROI 2015.......http://www.natap.org/2015/CROI/croi_45.htm
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Is diabetes prevalence higher among HIV-infected individuals compared
with the general population? Evidence from MMP and NHANES 2009-2010 - YES 10.4% vs 7.1%, 19.6% in older Aging HIV+ - HCV Increases Diabetes Risk
http://www.natap.org/2017/HIV/020617_04.htm
The unadjusted prevalence of DM (CI) among HIV-infected adults was 10.3% (9.1% to 11.5%), and was higher compared with the general US adult population (8.3% (7.2% to 9.4%)) as well as the general US adult population having received care in the previous 12 months (9.7% (8.4% to 11.1%)) (data not shown).
After adjusting for differences in distributions of sex, age, race/ethnicity, education, poverty, obesity, and HCV infection prevalence, the adjusted difference of DM in HIV-infected adults versus the general US adult population was 3.8% (table 2) [11.8 vs 8.0, among whites 11.4 vs 6.5, among blacks 13.1 vs 11.8].
The largest difference in DM prevalence among HIV-infected adults relative to their counterparts in the general US adult population occurred among those with HCV infection (6.3%),
Among HIV-infected adults, DM prevalence varied by selected characteristics (table 4). The adjusted DM prevalence was lowest among those aged 20-44 years (6.7%) and highest among those aged ≥60 years (19.6%), and obese (18.9%) (table 4). Factors independently associated with total DM among HIV-infected adults included increasing age, obesity, increasing time since HIV diagnosis, and geometric mean CD4.
Table 3 Predicted marginal prevalence and prevalence comparisons of diagnosed diabetes among HIV-infected adults and general US population adults having received
medical care in the previous 12 months, MMP and NHANES 2009-2010
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