Under-utilisation of cardioprotective glucose-lowering medication in diabetics living with HIV

Butale, Bakani; Woolley, Ian; Cisera, Kathryn; Korman, Tony M.; Soldatos, Georgia

doi:10.1071/sh22070

Cited by 2 publications

(2 citation statements)

References 6 publications

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“…Our findings on underutilization of SGLT2 inhibitors among PWH with DM2 receiving care in a large US Health care System compliment similar trends from a smaller cohort of PWH in Australia. 10 Such findings may reflect "clinical inertia" 11 or provider reluctance to adopt or intensify treatment with new therapeutics. With respect to reluctance in SGLT2 inhibitor prescribing, a survey-based study revealed that nonendocrinologists frequently reported discomfort in administering "diabetes medications" for purposes other than glucose-lowering (eg, cardiorenal protection).…”

Section: Discussionmentioning

confidence: 99%

Brief Report: Use and Side Effects of Sodium–Glucose Transporter 2 Inhibitors Among US People With HIV With Clinical Indications

Sise

Katz-Agranov

Strohbehn

et al. 2023

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: Sodium–glucose transporter 2 (SGLT2) inhibitors have been approved for treatment of diabetes mellitus (DM), chronic kidney disease, and heart failure, but little is known about prescription levels and safety profiles among people with HIV (PWH). Methods: We leveraged data from the US Mass General Brigham electronic healthcare database to determine the use/uptake of SGLT2 inhibitors among PWH with type II diabetes (DM2) (with or without chronic kidney disease, proteinuria, or heart failure) and to assess rates of adverse events among PWH with DM2 taking SGLT2 inhibitors. Results: Among eligible PWH with DM2 receiving care at US Mass General Brigham (N = 907), SGLT2 inhibitors were prescribed to 8.8%. SGLT2 inhibitors were prescribed to a fraction of eligible PWH with DM2 and a concomitant diagnosis of chronic kidney disease (3.8%), proteinuria (13.2%), or heart failure (8.2%). PWH with DM2 on SGLT2 inhibitors experienced side effects (urinary tract infection, diabetic ketoacidosis, and acute kidney injury) at rates comparable with PWH with DM2 prescribed glucagon-like peptide-1 agonists. Rates of mycotic genitourinary infections were higher among those prescribed SGLT2 inhibitors (5% vs. 1%, P = 0.17), but no cases of necrotizing fasciitis ensued. Conclusions: Additional studies are needed to characterize population-specific salutary and adverse effects of SGLT2 inhibitors among PWH and potentially augment prescription rates when guideline indicated.

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Section: Discussionmentioning

confidence: 99%

Brief Report: Use and Side Effects of Sodium–Glucose Transporter 2 Inhibitors Among US People With HIV With Clinical Indications

Sise

Katz-Agranov

Strohbehn

et al. 2023

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…Additionally, the lack of financial reimbursement of these medications may hinder their wide-scale usage in many settings. Generally, evidence showed that GLP-1 agonists are still under-utilized in diabetic patients with HIV [24]. Here, we focus on the potential benefits of liraglutide and semaglutide in people with HIV, and various therapeutic considerations to be warranted.…”

Section: Introductionmentioning

confidence: 99%

GLP‐1 agonists for people living with HIV and obesity, is there a potential?

et al. 2023

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Background and objectivesObesity trends and metabolic dysregulation are rising in people living with HIV using antiretrovirals (ARVs). Underlying causes and preventive strategies are being investigated. Two glucagon like‐peptide 1 (GLP‐1) agonists, liraglutide and semaglutide, were formerly approved as glucose‐lowering drugs and have been recently approved for long‐term weight loss in people with obesity. Due to the lack of therapeutic guidelines or clinical trials in people with HIV, we discuss the potential benefits, safety aspects and pharmacological considerations of prescribing liraglutide and semaglutide in people with HIV.ResultsClinical experience is limited to two clinical cases of diabetic people with HIV using liraglutide after which a successful weight loss and glycaemic control were observed. None of the adverse events associated with liraglutide and semaglutide usage indicate an additional risk for people with HIV. Extra caution showed be warranted when initiating GLP‐1 agonist therapy in people with HIV taking protease inhibitors who have pre‐existing risk factors for heart rate variability to reduce the incidence of RP interval prolongation. GLP‐1 agonists are metabolized by endopeptidases, and thus do not generate major drug–drug interactions with most drugs, including ARVs. GLP‐s agonists are known to inhibit gastric acid secretion, which warrants caution and close monitoring when combined with atazanavir and oral rilpivirine, two ARVs that require low gastric pH for an optimal absorption.ConclusionTheoretical considerations and a few available clinical observations support semaglutide and liraglutide prescription in people with HIV, with, thus far, no indications of concern regarding efficacy, safety or pharmacological interactions with ARVs.

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Under-utilisation of cardioprotective glucose-lowering medication in diabetics living with HIV

Cited by 2 publications

References 6 publications

Brief Report: Use and Side Effects of Sodium–Glucose Transporter 2 Inhibitors Among US People With HIV With Clinical Indications

Brief Report: Use and Side Effects of Sodium–Glucose Transporter 2 Inhibitors Among US People With HIV With Clinical Indications

GLP‐1 agonists for people living with HIV and obesity, is there a potential?

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