Prevalence of obesity and disturbances in glucose homeostasis in HIV‐infected subjects and general population – missed diagnoses of diabetes?

Abstract

Objectives Comparative data on glucose disorders using fasting blood samples between people living with HIV (PLWH) and the general population are lacking. The objective of this study was to compare the prevalence and risk factors of obesity and disturbances in glucose homeostasis between PLWH treated with modern antiretroviral therapy and the general population. Methods Adjusted prevalence of obesity, features of insulin resistance (triglyceride:high‐density lipoprotein cholesterol ratio and alanine aminotransferase), impaired fasting glucose (IFG), diabetes mellitus (DM) and combined dysglycaemia (presence of IFG or DM) were determined using fasting blood samples among 1041 PLWH and 7047 subjects representing the general population. Results People living with HIV had a lower prevalence of obesity [18.2%, 95% confidence interval (CI): 15.1–21.2 vs. 23.9%, 95% CI: 22.4–25.4], but a higher prevalence of insulin resistance and IFG (20.0%, 95% CI: 16.6–23.4 vs. 9.8%, 95% CI: 8.7–10.8) than the general population. Fasting glucose concentration was higher, but glycated haemoglobin (HbA1c) was lower, among PLWH. Prevalence of dysglycaemia for a given body mass index (BMI) was higher in PLWH than in the general population. The prevalence of DM did not differ between PLWH (13.2%, 95% CI: 10.2–15.9) and the general population (14.5%, 95% CI: 13.6–15.4). Conclusions The prevalence of obesity was lower, but the risk of dysglycaemia for a given BMI was significantly higher, among PLWH, highlighting the importance of prevention and treatment of obesity among HIV‐infected subjects. Regardless of the increased prevalence of insulin resistance and IFG, DM was surprisingly not more common among PLWH, raising concern about the under‐diagnosis of DM, possibly due to low sensitivity of HbA1c in this patient population.

Comparison of HIV-Infected and Noninfected Patients Undergoing Bariatric Surgery: The ObeVIH Study

“…6 In the Finnish population, 18.2% PLWH of median age 50 years were obese and 23.9% were noninfected controls. 7…”

“…6 In the Finnish population, 18.2% PLWH of median age 50 years were obese and 23.9% were noninfected controls. 7 Bariatric surgery (BS), including sleeve gastrectomy (SG), is a well-established option for the management of weight loss and weight-related metabolic diseases in non-HIV-infected subjects. 8 SG has gained popularity worldwide because of its excellent results, regarding weight loss and resolution of comorbidities, and its safety.…”

Switching from tenofovir alafenamide to tenofovir disoproxil fumarate improves lipid profile and protects from weight gain

“…As the pathogenesis of diabetes mellitus is tightly linked to obesity [23], excessive weight gain among PHIV leads to concerns of rising prevalence of dysglycaemia in this population. Hanttu et al demonstrated that risk of dysglycemia for any given BMI was significantly higher among PHIV compared to the general population, underlining the importance of preventing obesity among these patients [24]. Our study indicates that switching from TAF to TDF could be one tool to control body weight among PHIV.…”

Trends in diabetes incidence and associated risk factors among people living with HIV in the current treatment era, 2008-2018

“…This finding confirms previous studies in which higher BMI was associated with diabetes diagnosis and impaired fasting glucose levels. 6, 16, 17 Given the rising diabetes rates among these PWH and added metabolic risks of HIV infection and ART, more resources should be devoted to curb excess body fat gain and related conditions in this particularly vulnerable population.…”