Association of HIV-1 Infection and Antiretroviral Therapy With Type 2 Diabetes in the Hispanic Population of the Rio Grande Valley, Texas, USA

Abstract

The Rio Grande Valley (RGV) in South Texas has one of the highest prevalence of obesity and type 2 diabetes (T2D) in the United States (US). We report for the first time the T2D prevalence in persons with HIV (PWH) in the RGV and the interrelationship between T2D, cardiometabolic risk factors, HIV-related indices, and antiretroviral therapies (ART). The PWH in this study received medical care at Valley AIDS Council (VAC) clinic sites located in Harlingen and McAllen, Texas. Henceforth, this cohort will be referred to as Valley AIDS Council Cohort (VACC). Cross-sectional analyses were conducted using retrospective data obtained from 1,827 registries. It included demographic and anthropometric variables, cardiometabolic traits, and HIV-related virological and immunological indices. For descriptive statistics, we used mean values of the quantitative variables from unbalanced visits across 20 months. Robust regression methods were used to determine the associations. For comparisons, we used cardiometabolic trait data obtained from HIV-uninfected San Antonio Mexican American Family Studies (SAMAFS; N = 2,498), and the Mexican American population in the National Health and Nutrition Examination Survey (HHANES; N = 5,989). The prevalence of T2D in VACC was 51% compared to 27% in SAMAFS and 19% in HHANES, respectively. The PWH with T2D in VACC were younger (4.7 years) and had lower BMI (BMI 2.43 units less) when compared to SAMAFS individuals. In contrast, VACC individuals had increased blood pressure and dyslipidemia. The increased T2D prevalence in VACC was independent of BMI. Within the VACC, ART was associated with viral load and CD4+ T cell counts but not with metabolic dysfunction. Notably, we found that individuals with any INSTI combination had higher T2D risk: OR 2.08 (95%CI 1.67, 2.6; p < 0.001). In summary, our results suggest that VACC individuals may develop T2D at younger ages independent of obesity. The high burden of T2D in these individuals necessitates rigorously designed longitudinal studies to draw potential causal inferences and develop better treatment regimens.

Examining incidence of diabetes in people with HIV: tracking the shift in traditional and HIV-related risk factors

“…Among traditional risk factors, our study found age, hypertension, dyslipidemia, and obesity to be positively associated with DM among PWH, which is similar to findings from previous studies [1,38,[45][46]. Previous studies also noted low CD4 þ cell count as risk factor for DM among PWH [1,45].…”

HIV Protease Inhibitors and Insulin Sensitivity: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…From the aforementioned analysis, we can conclude that more RCTs need to be done with a comparison of HOMA IR with the other methods (OsGTT, HbA1c). Treating patients with DM is complex due to the progressive nature of the disease ( Gebrie et al, 2021a ; Gebrie et al, 2021b ), and the burden could be higher in HIV comorbidity ( Godman et al, 2020 ; Ye et al, 2020 ; Lopez-Alvarenga et al, 2021 ; Phoswa, 2021 ) that calls for more robust studies in the area.…”

Metformin Treatment Leads to Increased HIV Transcription and Gene Expression through Increased CREB Phosphorylation and Recruitment to the HIV LTR Promoter

“…These include HIV-associated neurocognitive disorders [3][4][5][6], hypertension and cardiovascular diseases [7][8][9][10], renal impairment [11,12], lipodystrophy [13][14][15][16][17], dyslipidemia [18,19], premature/rapid aging [7,[20][21][22], insulin resistance, and diabetes mellitus [23][24][25]. The main attributing factors are lifestyle, host factors, HIV-related inflammation, and ART [26][27][28][29][30][31][32][33][34]. The incidence of type 2 diabetes is higher among HIV-infected individuals, as ART is often linked to insulin resistance and metabolic dysfunction [23,[35][36][37][38][39].…”