Diabetes isn't adequately managed in women with HIV, says US research

Optimum targets for control of type 2 diabetes are achieved in only 11% of women with HIV or at risk of HIV, according to US research published in Open Forum Infectious Diseases. The proportion of women attaining these targets did not differ according to HIV status. Participants were monitored over a 15-year period. The proportion of HIV-positive women with viral control more than doubled during the period of analysis, but the percentage meeting key markers for control of type 2 diabetes remained low throughout the study.

“We found that HIV control (i.e., viral suppression) has improved over time, but DM [diabetes mellitus] control has not,” write the authors. “Overall, these findings reinforce the importance of considering HIV a chronic infectious disease, for which the aggressive management of comorbid cardio-renal risk factors, such as diabetes, will be important.”

With modern antiretroviral therapy, most people with HIV now have an excellent life expectancy. Co-morbid diseases, however, are an increasingly important cause of serious illness and death in HIV-positive individuals. In the United States, the HIV and type 2 diabetes epidemics are converging, with prevalence approximately 60% higher among people with HIV compared to the general population. HIV-positive individuals are more likely to develop diabetes at a younger age and without obesity than their HIV-negative peers.

Both HIV and diabetes have independent associations with cardiovascular disease. It is therefore important to ensure that both conditions are effectively controlled.

Investigators from the Women’s Interagency HIV Study (WIHS) wanted to determine the proportion of diabetic women with or at risk of HIV who were engaged in care and who were attaining key targets for diabetes control.

Engagement with care was defined as attending semi-annual follow-up appointments.

Diabetes control was defined as the ABC treatment targets of haemoglobin (A1c) below 7%; blood pressure below 140/90mmHg; low-density lipoprotein (LDL) cholesterol below 100mg/dL; and not smoking. Data were also collected on the proportion of HIV-positive women with viral suppression (viral load below 200 copies/ml).

Participants were monitored at three time points: 2001, 2006 and 2015.

The study population consisted of 486 HIV-positive women and 258 HIV-negative women with confirmed type 2 diabetes.

There was a high level of engagement with care (approximately 92%) at all three time points.

The proportion of women attaining the A1c target was 61% in 2001, 73% in 2006 and 58% in 2015. Approximately 70% of women attained the blood-pressure target across the three study intervals. There was a small increase in the percentage of participants meeting the cholesterol target: 39% in 2001, 48% in 2006 and 53 in 2016. The proportion of women who reported not smoking increased from 49% in 2001 to 60% in 2015.

The combined ABC target was achieved by 23% in 2001, 26% in 2006 and 22% in 2015. Although low, the authors note that these figures are similar to those observed in the general US population.

But even fewer women attained the ABC targets plus not smoking (11% in 2001, 13% in 2005 and 11% in 2015).

HIV-positive women had higher levels of engagement with care than the HIV-negative women. In 2015, women with HIV were also significantly more likely to report not smoking (64% vs 49%, p = 0.04). But overall and throughout the 15 years of the study, attainment of the ABC targets did not differ significantly according to HIV status. Nor was any difference observed in terms of ABC plus not smoking.

However, the proportion of HIV-positive women with viral control increased from 40% in 2001, to 62% in 2006 and 91% in 2015. There was no association between viral suppression and increased likelihood of attaining a diabetes control measure.

“Though there were no differences in DM control between HIV-positive and HIV-negative women, DM control was poor in both groups. In contrast, HIV control…did improve from 2001 to 2015 among HIV-positive women, though viral suppression was not associated with better DM control,” conclude the authors. “Identifying the barriers and possible innovations for how to optimize management of these comorbidities is a priority across all aspects of the health care and research continuum.”