People infected with HIV are more affected by diabetes than the general population. This possible risk factor has so far been ignored.
HIV and diabetes. The association is unfortunate, but it does exist. The metabolic disorder is more prevalent in people with HIV compared to the general population. This is shown by a study conducted in part by the US Centers for Disease Control and Prevention. Published in the BMJ Open Diabetes Research & Care, she emphasizes the importance of focusing more on the co-morbidities of HIV infection.
The proportion of diabetics among seropositive people is 4% higher than in the general population. To arrive at this figure, the researchers compared the health status of 8,600 people infected with HIV to that of 5,600 healthy people, representative of the American population. The result is clear: 8% of Americans have diabetes. Among people living with HIV, this proportion climbs to just over 10%.
Younger patients
Obesity and age are, not surprisingly, major risk factors. But even in their absence, the metabolic disorder is more present. This is especially the case with women. “Comparison with the general American adult population shows that people living with HIV have more diabetes, at younger ages and in the absence of obesity,” the authors explain. A particularly strong association which is reinforced with the years spent with HIV as well as the number of CD4 T lymphocytes remaining.
The researchers recognize that this result must be confirmed, in particular in order to define the origin of this over-representation. They recommend in-depth work with a specific objective: to determine whether HIV should be considered a risk factor in its own right. This would in fact change a significant part of the field of prevention.
Side effects ignored
If the American team is cautious, this is not the case for the entire medical profession. As early as 2005, Cecilia Yoon – from Cornell University (United States) – took a stand in favor of regular monitoring of fasting blood sugar in patients on protease inhibitors or with lipodystrophy – a side effect of certain anti- HIV.
She develops her reasoning in the review of the International Diabetes Federation. A piece of advice taken up by the activists of Act-Up Paris who put forward an even more worrying figure: the risk of diabetes would be multiplied by four in people living with HIV.
This association could have its source in the treatments which make it possible to control the infection with a high efficiency. Several studies have suggested that antiretrovirals could promote the emergence of type 2 diabetes, especially in women at genetic risk. But the impact of treatments on the virus could come at a higher price than expected: that of insulin resistance and chronic inflammation. Research suggests that certain classes – such as protease inhibitors – increase the likelihood of developing diabetes in the absence of obesity and at a young age.
These elements underline “the need to continuously assess other risk factors for diabetes in people living with HIV,” conclude the authors of this study. It will also be necessary to better understand the impact of treatments on insulin production and glucose control.
.
