Incidence of Diabetes Mellitus and Obesity and the Overlap of Comorbidities in HIV+ Hispanics Initiating Antiretroviral Therapy

Abstract

BackgroundCardiovascular disease (CVD) is a leading health threat for HIV+ patients on antiretroviral therapy (ART); cardiometabolic comorbidities are key predictors of risk. Data are limited on incidence of metabolic comorbidities in HIV+ individuals initiating ART in low and middle income countries (LMICs), particularly for Hispanics. We examined incidence of diabetes and obesity in a prospective cohort of those initiating ART in the Dominican Republic.MethodsParticipants ≥18 years, initiating ART <90 days prior to study enrollment, were examined for incidence of impaired fasting glucose (IFG), diabetes mellitus (DM), overweight, and obesity. Fasting plasma glucose (FPG) 100-125mg/dl defined IFG; FPG ≥126 mg/dl, diagnosis per medical record, or use of hypoglycemic medication defined DM. Overweight and obesity were BMI 25–30 and ≥30kg/m2, respectively. Dyslipidemia was total cholesterol ≥240mg/dl or use of lipid-lowering medication. Framingham risk equation was used to determine ten-year CVD risk at the end of observation.ResultsOf 153 initiating ART, 8 (6%) had DM and 23 (16%) had IFG at baseline, 6 developed DM (28/1000 person-years follow up [PYFU]) and 46 developed IFG (329/1000 PYFU). At baseline, 24 (18%) were obese and 36 (27%) were overweight, 15 became obese (69/1000 PYFU) and 22 became overweight (163/1000 PYFU). Median observation periods for the diabetes and obesity analyses were 23.5 months and 24.3 months, respectively. Increased CVD risk (≥10% 10-year Framingham risk score) was present for 13% of the cohort; 79% of the cohort had ≥1 cardiometabolic comorbidity, 48% had ≥2, and 13% had all three.ConclusionsIn this Hispanic cohort in an LMIC, incidences of IFG/DM and overweight/obesity were similar to or higher than that found in high income countries, and cardiometabolic disorders affected three-quarters of those initiating ART. Care models incorporating cardiovascular risk reduction into HIV treatment programs are needed to prevent CVD-associated mortality in this vulnerable population.

Obesity following ART initiation is common and influenced by both traditional and HIV-/ART-specific risk factors

“…[1][2][3] Among individuals on suppressive ART, wasting has become less common and recent studies from both upper-and lower-income countries report weight gain irrespective of ART type. [4][5][6][7][8] Additionally, many countries have reported an increasing prevalence of overweight and obese states in HIV-infected persons even prior to ART initiation, consistent with trends in the general population. 6,9 As obesity rates rise, so does the risk for obesity-related complications.…”

Risk factors associated with overweight and obesity in HIV-infected people

“…[ 6 , 15 , 16 ] As in the general population, overweight and obesity are associated with a number of detrimental health conditions in HIV-infected patients, including cardiovascular diseases and diabetes. [ 16 – 20 ] This study confirms that the prevalence of diabetes and cardiovascular disease is high in HIV-infected patients, and that overweight and obesity increasing in this population add excess risk of these comorbidities. BMI distribution of patients starting cART is similar to that of the general population, but there is a significant risk of BMI gain during the first years after cART initiation.…”

HIV Co-Morbidities and Multi-Morbidities

“…Similarly, HIV patients with high with CD4 counts receiving antiretroviral treatment displayed marked increases in body mass index, overweight/obesity, and central obesity among patients but not those with higher CD4 counts, implying that obesity risk was exacerbated by lower CD4 counts [63]. It is worth noting that in the Hispanic cohort (above) of HIV patients receiving antiviral therapy the incidence of obesity/overweight was similar to that witnessed in high income countries with the expected accompanying risks [61]. Further, Obesity linked to commonplace among HIV-infected Nigerians maintaining antiretroviral therapy [64].…”

“…Price et al [60] have obtained a tendency towards an increasing prevalence of metabolic syndrome and elevated risk for cardiovascular disorders among HIV patients in spite of the ageing population sample and lengthened duration of HIV-infection period and extended antiviral therapy over the course of one year. Gomes et al [61] found that, among a large cohort of Hispanic American HIV patients receiving antiviral therapy, significant proportions were either obese or overweight or on their way to developing obesity as well as diabetes mellitus. Reorientations of health care procedures are necessary for patients living with HIV in view of the exaggerated prevalence of overweightness and abdominal obesity linked to sociodemographic and clinical conditions expressed by the consumption of risk foods [62].…”