Successful Management of HIV Is Outpacing That of Diabetes in Women

Among HIV-positive women with diabetes, HIV control has improved over time, but diabetes control has not, according to new study results.

Through the widespread adoption of antiretroviral therapy, HIV has become a manageable chronic disease with a similar life expectancy to those without the disease. However, with longer life expectancies comes the comorbidities for this patient population. It is predicted that up to 84% of people with HIV will have at least 1 non-communicable, chronic disease by 2030, according to the study published in Open Forum Infectious Diseases. Notably, people living with HIV have are 1.6 times more likely to develop type 2 diabetes.

“Although older age and obesity are associated with the development of diabetes, data show that people living with HIV are more likely to develop diabetes at younger ages and without obesity compared to the general population,” wrote the authors of the study. “The dual diagnosis of HIV and diabetes is troubling given their independent association with higher risk of cardiovascular disease, the leading cause of mortality in people living with HIV.”

Noting a lack of research on achievement of diabetes treatment goals among people living with HIV, researchers collected data from the Women’s Interagency HIV Study, the largest multicenter, prospective cohort study of comparable HIV-positive and HIV-negative women. Data from 2001, 2006, and 2015 were analyzed. A total of 486 HIV-positive and 258 HIV-negative women with diabetes were included.

Participants completed semiannual study visits consisting of a physical exam, collection of serum and plasma for laboratory analyses, and an interview-administered survey on demographics, social characteristics, disease characteristics, and medication-related information.

Results showed that most women visited a healthcare provider since their last study visit across all 3 time points (91.8% in 2001, 91.4% in 2006, and 92.2% in 2015. The proportion of women achieving the A1c goal of less than 7% was 60.7% in 2001, 73.2% in 2006, and 58% in 2015.

Meanwhile, the blood pressure goal—systolic blood pressure of less than 140 mmHg and diastolic blood pressure of less than 90 mmHg—was similar across all 3 time points (70.5%, 74.5%, and 72.8%, respectively). There was a small but steady increase in the proportion of women achieving the cholesterol goal of low-density lipoprotein less than 100 mg/dL (38.5%, 47.5%, and 53.2%, respectively).

The proportion of women who achieved all 3 targets was low across all time points (23.3%, 26.4%, and 22.3%, respectively).

The researchers observed no differences in achieving any of the diabetes care goals between HIV-positive and HIV-negative women. In 2006, more HIV-positive women saw a healthcare provider (96% vs 80.4%) and achieved blood pressure control (79.3% vs 63%).

Notably, the proportion of HIV-positive women who achieved viral suppression nearly doubled over the period, increasing from 40.7% in 2001 to 86.9% in 2015.

“Among HIV-positive women, we found HIV control has improved over time, but diabetes control has not,” wrote the authors. “HIV-negative women, however, did have significant improvement in glycemic control from 2001 to 2015.”

They concluded that these findings reinforce the importance of considering HIV as a chronic infectious disease where management of comorbidities, such as diabetes, is important.

Reference:

Colasanti J, Galaviz K, Mehta C, et al. Room for improvement: the HIV-diabetes care continuum over 15 years in the Women's Interagency HIV Study [published online May 22, 2018]. Open Forum Infect Dis. doi: https://doi.org/10.1093/ofid/ofy121.