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Is diabetes prevalence higher among HIV-infected individuals compared with the general population? Evidence from MMP and NHANES 2009-2010
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BMJ Diabetes Research & Care Open Access 2017
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Among a nationally representative US sample of HIV-infected adults receiving medical care in 2009 and 2010, the DM prevalence was 10.3%; increasing age, obesity, longer duration of HIV infection, and geometric mean CD4 [higher cd4] were independently associated with a higher DM prevalence. When compared with the general US adult population, HIV-infected individuals had a 3.8% higher prevalence of DM after adjusting for age, sex, race/ethnicity, education, poverty-level, obesity, and HCV infection. This analysis provides the first nationally representative estimate of DM burden among HIV-infected adults and suggests that HIV-infected persons may be more likely to have DM at younger ages and in the absence of obesity compared with the general US adult population.
We observed a strong association between both increasing age and obesity and prevalent DM among HIV-infected individuals.
HIV-infected women had a 5% higher prevalence than their counterparts in the general population, an effect that was independent of obesity. There is evidence that the use of ART may increase conversion to DM among women with high-risk genetic polymorphisms.
Beyond the effect of ART on insulin resistance and development of DM, chronic inflammation during HIV infection may accelerate the development of comorbid conditions such as DM.
There is a continued need for research assessing other important risk factors for DM among HIV-infected individuals, including diet and exercise, as well as a deeper understanding of insulin and glucose homeostasis in the setting of HIV infection.
although HCV has been described as a risk factor for DM in the general population, our findings indicate that HIV may compound the deleterious effects of HCV, putting HIV/HCV coinfected individuals at even higher risk of DM
HIV-care providers should follow existing DM screening guidelines, which recommend FBG and HbA1c be obtained prior to and after starting ART.
• If you have diabetes, you're twice as likely to have heart disease or a stroke than someone who doesn't have diabetes—and at a younger age. The longer you have diabetes, the more likely you are to have heart disease. (CDC)
• But the good news is that you can lower your risk for heart disease and improve your heart health by changing certain lifestyle habits. CDC
What Is Heart Disease?
Heart disease includes several kinds of problems that affect your heart. The term "cardiovascular disease" is similar but includes all types of heart disease, stroke, and blood vessel disease. The most common type is coronary artery disease, which affects blood flow to the heart.
Coronary artery disease is caused by the buildup of plaque in the walls of the coronary arteries, the blood vessels that supply oxygen and blood to the heart. Plaque is made of cholesterol deposits, which make the inside of arteries narrow and decrease blood flow. This process is called atherosclerosis, or hardening of the arteries. Decreased blood flow to the heart can cause a heart attack. Decreased blood flow to the brain can cause a stroke.
Hardening of the arteries can happen in other parts of the body too. In the legs and feet, it's called peripheral arterial disease, or PAD. PAD is often the first sign that a person with diabetes has cardiovascular disease.
Methods We used nationally representative survey (2009-2010) data from the Medical Monitoring Project (n=8610 HIV-infected adults) and the National Health and Nutrition Examination Survey (n=5604 general population adults) and fit logistic regression models to determine and compare weighted prevalences of DM between the two populations, and examine factors associated with DM among HIV-infected adults.
Results DM prevalence among HIV-infected adults was 10.3% (95% CI 9.2% to 11.5%). DM prevalence was 3.8% (CI 1.8% to 5.8%) higher in HIV-infected adults compared with general population adults. HIV-infected subgroups, including women (prevalence difference 5.0%, CI 2.3% to 7.7%), individuals aged 20-44 (4.1%, CI 2.7% to 5.5%), and non-obese individuals (3.5%, CI 1.4% to 5.6%), had increased DM prevalence compared with general population adults. Factors associated with DM among HIV-infected adults included age, duration of HIV infection, geometric mean CD4 cell count, and obesity.
Conclusions1 in 10 HIV-infected adults receiving medical care had DM. Although obesity contributes to DM risk among HIV-infected adults, comparisons to the general adult population suggest that DM among HIV-infected persons may develop at earlier ages and in the absence of obesity.
Conclusion
We presented the first nationally representative estimate of DM prevalence among HIV-infected adults receiving medical care in the USA in 2009-2010 where 1 in 10 HIV-infected adults had a diagnosis of DM. Although obesity is a risk factor for prevalent DM among HIV-infected adults, when compared with the general US adult population, HIV-infected adults may have higher DM prevalence at younger ages and in the absence of obesity. Healthcare providers caring for HIV-infected patients should follow existing DM screening guidelines. Given the large burden of DM among HIV-infected adults, additional research would help to determine whether DM screening guidelines should be modified to include HIV infection as a risk factor for DM and to identify optimal management strategies in this population.
Factors independently associated with total DM among HIV-infected adults included increasing age, obesity, increasing time since HIV diagnosis, and geometric mean CD4 with higher CD4 cunt having highest prevalence of diabetes - see Table 4. Having been prescribed ART was just below statistically significant for increased prevalence for diabetes.
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%), those with a high school or equivalent education (5.1%), women (5.0%), non-Hispanics whites (4.9%), individuals living at or below the poverty line (4.6%), obese individuals (4.4%) and ages 20-44 years (4.1%). After restricting the NHANES population to adults who had received care in the previous 12 months, associations were similar to those described above with a slight decrease in the magnitude of DM PD (table 3).
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