World AIDS Day 2021: Diabetes In People With HIV - Risk Factors, Complications And Treatments

HIV And Diabetes

People living with HIV infection are prone to developing diabetes compared to people without the infection. The burden of diabetes in people with HIV infection can be challenging for both patients and caretakers.

A study has shown that the incidence of diabetes is four times more common in people with HIV infection and on HIV therapy, compared to those who are not on HIV therapy and who are HIV negative. [2]

Also, the prevalence of developing diabetes in regard to HIV disease is growing in low and middle-income countries. This could possibly be due to factors like urbanisation. [3]

With the increase in urban settings and facilities, people are moving more towards sedentary and stressful lifestyles, along with reduced consumption of nutritious food and more pesticide-based foods, leading to increased risks of obesity, heart diseases, depression and diabetes.

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Risk Factors Of Developing Diabetes In People With HIV

1. Antiretroviral therapies (ART)

ART is considered to be the first line of treatment for people living with HIV. It includes the use of drugs or medications to prevent the virus replication, repair the immune system and prevent disease progression. As treatment with ART is growing, the incidence of HIV-associated diabetes is also increasing. This is because of the negative effects of some of these ART drugs like indinavir on insulin production and functions, thus leading to insulin resistance and then, diabetes. [4]

2. Overweight

As per a 2021 study, more than 40 per cent of people with HIV who were about to start the ART treatment were obese or overweight. Also, within two years of the start of the ART treatment, the percentage of people with normal or underweight have decreased and there was an increase observed in the percentage of overweight patients. The study adds that the use of protease inhibitors drugs like saquinavir in ART could be the main cause of increased body weight. [5]

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3. Hepatitis C Co-infection

People with HIV are at higher risk of infections due to their suppressed immune systems. A study has shown that around 25 per cent of people living with AIDS are co-infected with hepatitis C virus (HCV), which could be among the primary causes of developing diabetes. HCV can increase the risk of chronic kidney damage, liver damage and heart diseases. As the kidney helps in glucose balance by its release, uptake and reabsorption, damage to it can lead to increased sugar levels in the blood and thus, risk of diabetes. However, people who have received treatment for hepatitis C are less likely to develop diabetes than those who have not. [2]

4. Inflammation

Inflammation could also be one of the risk factors for developing diabetes in people with HIV infection. Inflammation can be triggered due to multiple factors like multiplication of virus, co-infection with another virus (like HCV) and imbalance of gut microbiota. Though HIV treatments mainly focus on reducing inflammation, some inflammatory biomarkers like cystatin C levels (a marker of kidney function) may not reduce up to their minimum levels, and thus, its increased levels for a longer period can cause diabetes. [6]

5. Other risk factors

Age (being 45 years or over), having a family of diabetes, lack of exercise, inadequate diet, belonging to ethnicity/race of African American, Asian American or Hispanic/Latino.

Complications Linked To Diabetes In People With HIV

HIV and diabetes both can cause complications like:

• Damage to the nerves causing foot ulcers or amputations.
• Damage to kidney cells causing chronic kidney diseases.
• Eyes diseases like CMV retinitis and ischemic HIV retinopathy.
• Heart diseases such as blood pressure and cholesterol. [7]
• Death
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Diagnosing Diabetes In People With HIV

People with HIV should have their glucose levels checked before starting the treatment for the prior. This is an essential step as it will help a medical expert to prescribe medications accordingly.

Some of the suggested diagnostic methods by the American Diabetes Association (ADA) for identifying diabetes in HIV patients are CD4 cell count, fasting plasma glucose and/or haemoglobin A1c. However, these methods can sometimes give inaccurate results for people with HIV compared to the general population. [8]

Therefore, self-monitoring of glucose levels is considered to be the preferable way to keep eye on your glucose levels if you have an HIV infection.

Treatments For Diabetes In People WIth HIV

Every individual with HIV has a different rate of severity, and if they are also diagnosed with diabetes, then treatment in each case may again vary.

Also, the general treatment that works for people with HIV may not work for people with both HIV and diabetes as some diabetes drugs may interact with HIV drugs.

The main focus of the treatment should be to manage glucose levels and prevent the risk of complications.

Some of the treatment methods for people with HIV and diabetes may include:

• Medications: It includes prescribed medications like metformin, sulfonylureas and DPP4 Inhibitors, along with administration of insulin. Medications must be prescribed by the medical expert according to the patient's medical history such as his weight, any preexisting heart diseases or financial abilities to afford medications. [2]
• Lifestyle management: Modification in lifestyle habits such as quitting smoking, managing weight, indulging in regular physical activities and eating a proper diet can help manage both diabetes and HIV- related symptoms to a great extent.
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To Conclude

The study on the association between HIV infection and diabetes is a complicated subject and is poorly understood. However, diabetes or other metabolic diseases like heart disease along with HIV can negatively impact the survival rates of people.

By the introduction of more effective medications and early diagnosis and treatment of diabetes in people with high risk can help lower the morbidity and mortality due to diabetes in people with HIV infection.