Diabetes mellitus burden among people living with HIV from the Asia‐Pacific region

Abstract

IntroductionComorbidities including diabetes mellitus (DM) among people living with HIV (PLHIV) are of increasing clinical concerns in combination antiretroviral therapy (cART) era. We aimed to determine the incidence and risk factors of new‐onset DM among PLHIV in Asian settings.Methods PLHIV from a regional observational cohort without DM prior to antiretroviral therapy (ART) initiation were included in the analysis. DM was defined as having a fasting blood glucose ≥126 mg/dL, glycated haemoglobin ≥6.5%, a two‐hour plasma glucose ≥200 mg/dL, or a random plasma glucose ≥200 mg/dL. A Cox regression model, stratified by site, was used to identify risk factors associated with DM.Results and discussionOf the 1927 participants included, 127 were diagnosed with DM after ART initiation. Median follow‐up time from ART initiation to DM diagnosis was 5.9 years (interquartile range (IQR): 2.8 to 8.9 years). The crude incidence rate of DM was 1.08 per 100 person‐years (100 PYS), 95% confidence interval (CI) (0.9 to 1.3). In the multivariate analysis, later years of follow‐up (2011 to 2013: HR = 2.34, 95% CI 1.14 to 4.79, p = 0.02; and 2014 to 2017: HR = 7.20, 95% CI 3.27 to 15.87, p < 0.001) compared to <2010, older age (41 to 50 years: HR = 2.46, 95% CI 1.39 to 4.36, p = 0.002; and >50 years: HR = 4.19, 95% CI 2.12 to 8.28, p < 0.001) compared to <30 years, body mass index (BMI) >30 kg/m2 (HR = 4.3, 95% CI 1.53 to 12.09, p = 0.006) compared to BMI <18.5 kg/m2, and high blood pressure (HR = 2.05, 95% CI 1.16 to 3.63, p = 0.013) compared to those without high blood pressure, were associated with developing DM. The hazard was reduced for females (HR = 0.47, 95% CI 0.28 to 0.80, p = 0.006).ConclusionsType 2 DM in HIV‐infected Asians was associated with later years of follow‐up, high blood pressure, obesity and older age. This highlights the importance of monitoring and routine screening for non‐communicable diseases including DM as PLHIV age.

Statins for atherosclerotic cardiovascular disease prevention in people living with HIV in Thailand: a cost‐effectiveness analysis

“…Patients started in the healthy state and were at risk of coronary intervention without an MI, MI, ischaemic stroke, haemorrhagic stroke, cardiovascular death or non-CVD death. Coronary interventions included coronary artery bypass graft (CABG) and [24] Annual probability of developing diabetes Varies by age and sex b [25] Annual probability of smoking cessation c Varies by age b [26] Increase in systolic blood pressure per year of age Varies by age and sex b [27] Myocardial Infarction Probability of CVD event being fatal/non-fatal MI 0.488 (0.450 to 0.520) [24] Probability of CABG after MI c 0.031 (0.024 to 0.039) [28] Probability of PCI after MI c 0.288 (0.268 to 0.308) [28] Probability of MI being fatal c 0.177 (0.161 to 0.195) [28] Stroke Probability of CVD event being fatal/non-fatal stroke 0.292 (0.250 to 0.320) [24] Probability of stroke being ischemic c 0.693 (0.690 to 0.700) [29] Probability of ischemic stroke being fatal c 0. Varies by time since last stroke d [30,[37][38][39] Probability that recurrent ischemic stroke is fatal c 0.270 (0.140 to 0.420) [37] Probability of recurrent hemorrhagic stroke in first year after initial c 0.057 (0.015 to 0.409) [37] Probability of recurrent hemorrhagic stroke in subsequent years c Varies by individual e [37] Probability that recurrent hemorrhagic stroke is fatal c 0.430 (0.070 to 0.930) [37] Probability of ischemic stroke after MI c Varies by gender and time since MI d [37][38][39][40] Probability that ischemic stroke after MI is fatal c 0.270 (0.140 to 0.…”

The extents of metabolic syndrome among Antiretroviral Therapy exposed and ART naïve adult HIV patients in the Gedeo-zone, Southern-Ethiopia: a comparative cross-sectional study

“…As of the end of June 2019, 24.5 million people living with HIV (PLHIVs) were accessing the treatment [2]. This access was complemented with a 51% reduction in HIV mortality, from 1•95 million in 2006 to 0•95 million in 2017 [3], improved quality of life and survived longer [4,5].…”

<p>Predictors of Metabolic Syndrome Among People Living with HIV in Gedeo-Zone, Southern-Ethiopia: A Case–Control Study</p>

“…4 With such expanding global access to the treatment, the prognosis of HIV/AIDS is improved. [5][6][7][8] As a result, the worldwide morbidity and mortality from infectious diseases have occupied a backseat; 9 instead, non-HIV-related chronic conditions, non-communicable diseases (NCDs) are increasingly emerging. [9][10][11] The PLHIVs have high rates of NCDs 5,12 due to the acquisition of non-AIDSrelated comorbidities, like metabolic syndrome (MS).…”