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The impact of diabetes mellitus on HIV virologic control: results of the MACS/WIHS combined cohort study
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AIDS July 19, 2024
Our findings suggest that the presence of well-controlled DM may be linked to lower risk of viremia in highly adherent women with HIV.
The RR of incident viremia for women with uncontrolled DM (HbA1c>7.5%) was higher when compared to women with controlled DM (HbA1c <7.5%) (1.46
Conclusion
This study is the first study to assess the relationship between DM and incident HIV viremia among PWH. We observed that women with HIV and high ART adherence and DM had a lower rate of HIV viremia. Notably, women with high self-reported ART adherence and poorly controlled DM were at a higher risk of HIV viremia. This relationship was not found among men with HIV and DM.
These data suggest that DM control as well as health-conscious behavior, such as decreased rates of smoking and binge drinking, may be associated with HIV viremia in women with DM. As women with HIV age and develop obesity, they are more susceptible to DM and potentially increased rates of HIV viremia.
Abstract
Objective:
Diabetes mellitus (DM) is associated with lower antiretroviral (ART) drug exposure among persons with HIV (PWH) compared to PWH without DM. The association between DM and virologic control in PWH, however, remains unknown.
Methods:
We included participants in the Multicenter AIDS Cohort Study/Women's Interagency HIV Study Combined Cohort Study (MWCCS) who had initiated ART between 1999 and 2020 and had a suppressed HIV viral load (¡Ü200 copies/mL) within 1 year of ART initiation. We compared the frequency of incident HIV viremia (HIV-1 RNA >200 copies/mL) between adult PWH with and without DM. Poisson regression was used to examine the rate of incident viremia based on the diagnosis of DM among PWH. DM was defined as two consecutive fasting glucose measurements ¡Ý126 mg/dL, use of anti-diabetic medications, pre-existing DM diagnosis, or a confirmed HbA1c >6.5%.
Results:
1,061 women (112 with DM, 949 without DM) and 633 men (41 with DM, and 592 without DM) were included in the analysis. The relative rate (RR) of incident HIV viremia for women with HIV and DM was lower when compared to women without DM (0.85 [95% CI: 0.72šC0.99]; p = 0.04).
The RR of incident viremia for women with uncontrolled DM (HbA1c>7.5%) was higher when compared to women with controlled DM (HbA1c <7.5%) (1.46 [95%CI: 1.03šC2.07]; p = 0.03).
In contrast, the RR of incident viremia for men with HIV and DM was not statistically different compared to men without DM (1.2 [95%CI: 0.96- 1.50]; p = 0.12). The results were stratified by adherence levels (100%, 95šC99%, and less than 95% based on self-report).
Women with DM who self-reported 100% ART adherence had a lower RR of incident HIV viremia (0.7 [95%CI: 0.51-0.97]; p=0.03) than those without DM. In contrast, women with a self-reported adherence of 95-99% (1.19 [95%CI: 0.84-1.69]; p=0.32), and <95% (1.14 [95%CI: 0.85-1.53]; p=0.39), did not demonstrate a significant association between having DM and incident HIV viremia (Figure 3)
Among men, there was not a significant association between having a diagnosis of DM and the rate of HIV viremia episodes across all ART adherence levels: men who reported 100% (1.424 [95%CI: 0.946-2.17]; p=0.08), 95-99% (0.84 [95%CI: 0.5-1.40]; p=0.50) or <95% (1.06 [95%CI: 0.70-1.61]; p=0.7680) adherence (Figure 3)
Conclusions:
Women with DM who are highly adherent to ART (100% self-reported adherence) have a lower risk of viremia compared to women with HIV without DM. However, women with poorly controlled DM were at higher risk of HIV viremia than women with controlled DM. Further research is necessary to understand the impact of sex, DM, and ART adherence on HIV viremia.
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