The effect of HIV infection on glycaemia and renal function in type 2 diabetic patients

Abstract

BackgroundInfection with, and treatment of HIV is associated with effects on glycaemia and renal function. The purpose of this study was therefore to compare glycaemic control and albuminuria in HIV-positive and HIV-negative type 2 diabetic patients.Materials and methodsDiabetic patients with and without HIV infection were recruited from a diabetic clinic at Chris Hani Baragwanath Hospital in Soweto, South Africa. Data was collected on weight, height, HbA1c, fasting glucose, urine albumin:creatinine ratio, HIV status, CD4 counts, viral load and concomitant therapies. Multivariable regression analysis was used to isolate the determinants of fasting glucose and HbA1c levels and risk factors for albuminuria.ResultsData were collected from 106 HIV-positive and 214 HIV-negative diabetics. All HIV infected subjects were receiving anti-retroviral therapy. The determinants of fasting glucose levels (log) were HIV infection (β = 0.04, p = 0.01) and use of anti-hypertensive agents (β = 0.07, p = 0.0006), whilst for HbA1c levels (log) they were HIV infection (β = -0.03, p = 0.03), BMI (β = 0.004, p = 0.0005), statin use (β = 0.04, p = 0.002) and glucose levels (β = 0.01, p<0.0005). In HIV-positive subjects, CD4 counts were negatively associated with glucose levels (β = -0.0002, p = 0.03). The risk factors for albuminuria were (odds ratio [95% CIs]) dyslipidaemia (1.94 [1.09, 3.44], p = 0.02) and HbA1c levels (1.24 [1.12, 1.38], p<0.0001).DiscussionThese data suggest that glycaemic control is worse in type 2 diabetic subjects with HIV infection and that HbA1c underestimates glycaemia in these patients. Albuminuria was not associated with HIV-positivity. The negative relationship of CD4 counts with glucose levels may reflect viral removal and easing of the associated inflammatory response. It is possible that the association of statin and anti-hypertensive therapies with high HbA1c and glucose levels, respectively, is due to such therapies being given largely to subjects with poor glycaemic control.

The investigation of diabetes in people living with HIV: A systematic review

“…All reported a greater discrepancy between HbA 1c and FG in people living with HIV compared to the control group. Khoza et al 34 found people living with HIV had a higher FG, by 4.4%, but HbA 1c 2.8% lower in comparison to the control group. Slama et al 13 used multivariate median regression and found at a FG of 6.9 mmol/L (125 mg/dl) median HbA 1c were 0.21% lower in HIV‐infected men compared to HIV‐uninfected men.…”

“…Six studies used fasting glucose as an additional marker of glycaemia 13,34‐37 to monitor diabetes with one study 38 also using Fructosamine, five 13,34‐37 included a control cohort of participants without HIV. Four of the controlled studies compared HbA 1c and FG values.…”

Adult height and diabetes control: is there an association?

“…4 Relationships have been described between BMI and glycaemic control, but no studies were found, to our knowledge, on the association between adult height and glycaemic control in PLWD. In Soweto, South Africa (SA), Khoza et al 5 assessed the effect of HIV on glycaemia and renal function in patients with T2DM; however, no mention was made of any relationship between glycaemic control and patient height. Erasmus et al 6 assessed DM and metabolic syndrome in Cape Town, but also made no mention of any associations between height and glycaemic control.…”

“…Erasmus et al 6 assessed DM and metabolic syndrome in Cape Town, but also made no mention of any associations between height and glycaemic control. Glycaemic control in PLWD and HIV (PLWDH) has been shown to be suboptimal in SA 5 . Within the PLWDH cohort this can occur in those who are antiretroviral therapy (ART) naive, those on ART, as well as in those with a cluster of differentiation (CD4) level < 200 cell/μl.…”

“…Within the PLWDH cohort this can occur in those who are antiretroviral therapy (ART) naive, those on ART, as well as in those with a cluster of differentiation (CD4) level < 200 cell/μl. 5 Approximately 15% of patients living with HIV infection (PLWH) have co-morbid DM (PLWHD). 7 Pillay et al found that PLWHD had significantly poorer blood sugar control than in those PLWD alone.…”