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HIV in Women Better Managed Than Diabetes

JUN 04, 2018 | CONTAGION® EDITORIAL STAFF
The results of a new study reveal that rates of viral suppression in women infected with HIV have improved since 2001; however, control of diabetes mellitus (DM) has remained poor, regardless of HIV status.

As individuals who are living with HIV are living longer, thanks to the aid of antiretroviral therapy (ART), up to 84% of them will have at least 1 non-communicable, chronic disease (eg, diabetes) by the year 2030, according to the results of a study published in The Lancet Infectious Diseases. In fact, data have shown that individuals how are living with HIV have a “1.6 times adjusted-prevalence of DM compared with the general population.”

Because there remains a dearth of information on management and achievement of treatment goals, as well as the care continuum in patients with HIV who are also coinfected with DM, investigators from multiple institutions set out to learn more through an analysis of a prospective cohort study in women. The study is available online early in the journal, Open Forum Infectious Diseases.

Using data from the Women’s Interagency HIV Study (WIHS), “the largest multicenter, prospective cohort study of comparable HIV-positive and HIV-negative women aimed to investigate the natural history of women with HIV and those at risk for HIV infection in the United States,” according to the study. The investigators analyzed cross-sectional data taken from the study at 3 time points: 2001, 2006, and 2015. A total of 486 HIV-positive and 258 HIV-negative women with diabetes were included in the analysis. According to the study authors, confirmed diabetes was defined as “having at least 1 of the following: 1) self-reported use of antidiabetic medication; 2) a fasting glucose (FG) ≥126mg/dL, confirmed by A1c ≥ 6.5% or a subsequent FG ≥ 126 mg/dL; 3) a hemoglobin A1c ≥ 6.5%, confirmed by an FG ≥ 126 mg/dL; 4) a self-report of diabetes, confirmed by 2 FG ≥ 126 mg/dL; or 4) a hemoglobin A1c ≥ 6.5% concurrent with a FG ≥ 126 mg/dL.”

Study participants completed semiannual visits which included a physical exam (including blood pressure), blood tests (A1c, cholesterol, viral load, etc), and an interview-led survey on disease characteristics. “Medication use related to diabetes, hypertension, hyperlipidemia, and HIV was self-reported. The HIV viral load was measured using TaqMan® HIV-1 RNA, quantitative PCR,” study authors wrote.

Health measure goals were set as the following, per most recent guidelines for each:
  • A1c goal: <7.0%
  • BP goal: SBP < 140 mmHg and DBP < 90 mmHg
  • Cholesterol goal: LDL < 100 mg/dL
  • HIV viral suppression goal: last HIV-1 RNA as being < 200 copies/mL or undetectable
Participants also self-reported smoking vs nonsmoking.

The study results revealed that in 2001, while 91.8% of women reported visiting a health care provider, only 60.7% achieved the A1c target. Furthermore, “70.5% the BP target, 38.5% the LDL cholesterol target, and 49.2% were nonsmokers.” Only 23.3% achieved all 3 targets (A1c, BP, and cholesterol) and 10.9% met these combined targets and did not smoke. The investigators found similar patterns in 2006 and 2015 and HIV status did not affect these rates.

Conversely, viral suppression in HIV-positive women did increase over the time period, from 41% in 2001 to a whopping 87% in 2015.

The investigators conclude that these findings, “reinforce the importance of considering HIV as a chronic infectious disease where management of co-morbid cardiorenal risk factors, such as diabetes, is important.” Future consideration should be given to, “identifying the barriers and possible innovations for how to optimize management of these co-morbidities is a priority across all aspects of the healthcare and research continuum.”
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