Diabetes mellitus (DM) is a common condition with significant associated morbidity and mortality. DM diagnosis and management among human immunodeficiency virus (HIV)-infected patients is a particularly relevant topic as the HIV-infected population ages and more HIV-infected individuals live with chronic medical comorbidities. Although there is mixed evidence regarding HIV as an independent risk factor for DM, multiple factors related to HIV and its treatment are associated with DM. This review covers the epidemiology of DM in HIV-infected patients, and diagnosis, management, and treatment goals for DM in HIV-infected patients. We highlight the most recent DM treatment guidelines from the American Diabetes Association and the European Association for the Study of Diabetes, emphasizing individualization of DM medication therapy and treatment goals. Finally, we review a comprehensive approach to cardiovascular disease risk reduction in HIV-infected patients with DM and measures to prevent other complications of DM.

Background Poor retention in HIV care is associated with worse clinical outcomes and increased HIV transmission. We examined the relationship between self-reported alcohol use, a potentially modifiable behavior, and retention. Methods 9,694 people living with HIV (PLWH) from 7 participating U.S. HIV clinical sites (the CFAR Network of Integrated Clinical Systems (CNICS)) contributed 23,225 observations from January, 2011 to June, 2014. The retention outcomes were 1) Institute of Medicine (IOM) retention: 2 visits within 1 year at least 90 days apart and 2) visit adherence (proportion of kept visits / (scheduled + kept visits)). Alcohol use was measured with AUDIT-C, generating drinking (never, moderate, heavy) and binge frequency (never, monthly/less than monthly, weekly/daily) categories. Adjusted multivariable logistic models, accounting for repeat measures, were generated. Results 82% of our sample was male, 46% white, 35% black, and 14% Hispanic. At first assessment, 37% of participants reported never drinking, 38% moderate, and 25% heavy, and 89% of the patients were retained (IOM retention measure). Participants’ mean (SD) visit adherence was 84% (25%). Heavy alcohol use was associated with inferior IOM defined retention (adjusted OR (aOR) 0.78, 95% CI 0.69, 0.88), and daily/weekly binge drinking was associated with lower visit adherence (aOR=0.90, 95% CI 0.82, 0.98). Conclusions Both heavy drinking and frequent binge drinking were associated with worse retention in HIV care. Increased identification and treatment of heavy and binge drinking in HIV clinical care settings may improve retention in HIV care, with downstream effects of improved clinical outcomes and decreased HIV transmission.

BackgroundPeople with HIV are living longer with potent antiretroviral therapy (ART), and HIV is increasingly complicated by other chronic medical comorbidities. The objective of this study was to explore HIV-positive patients’ perspectives on living with HIV and diabetes mellitus (DM) or hypertension (HTN) and factors affecting medication adherence.MethodsWe conducted six focus groups. Two investigators independently coded transcripts for thematic content using editing style analysis. Codes were grouped into conceptual themes using consensus process.ResultsThirty-five HIV-positive patients with diabetes or hypertension participated. Four major themes emerged: (1) Comorbidities are a source of concern and frustration, sometimes eclipsing concern regarding HIV (2) Understanding of health conditions and medications promotes adherence, (3) Simpler regimens with fewer side effects promote adherence, and (4) Untreated substance abuse and mental health issues hinder adherence.ConclusionsHIV-positive patients in this study voiced concern regarding medical comorbidities and highlighted patient understanding, regimen factors, and substance abuse/mental health issues as barriers to adherence. Addressing these issues may improve outcomes in the aging HIV-positive population. Adherence to medications among HIV-positive patients with DM or HTN may be influenced by providing targeted disease-specific education, simplifying regimens, and treatment of substance abuse/mental health issues.