Diabetes and HIV
Purpose of Review
This review seeks to address the epidemiology and pathophysiological basis of the interaction between HIV infection and diabetes and the implication for treatment. Its importance stems from the current context of the growing burden of both conditions and the possible mechanisms of interactions that may exist but not yet sufficiently examined.
HIV infection is associated with increased risk of insulin resistance, and ART is associated with metabolic derangement and the occurrence of type 2 diabetes. The increasing survival among people with HIV infection in developing countries is paralleled by a growing burden of chronic non-communicable diseases (NCDs) especially cardiovascular diseases and diabetes mellitus. The prevalence of diabetes mellitus is higher in HIV-positive persons compared to the general population, and especially those with associated hepatitis C virus (HCV) co-infection. Antiretroviral therapy (ART) during chronic HIV infection is the most incriminated risk factor for the development of diabetes mellitus through diverse mechanisms depending on the ART leading to insulin resistance and increased inflammatory status.
A staggering 629 million of people 20–79 years are projected to have diabetes by 2045 while the world will soon enter the fourth decade of the HIV infection. Classical risk factors for diabetes such as physical inactivity and unhealthy diet may not solely explain the current trends, suggesting the role of novel risk factors including infections/inflammation. HIV and its treatment have been identified as potential contributors. Co-infections frequently observed during HIV infection also significantly influence both the epidemiological and pathophysiological of the link between HIV and diabetes. Although the relative contribution of each risk factor has not yet been quantified, several lines of evidence suggest that ART is a major contributor to hyperglycemia in HIV infection. ARTs have also led to an increase in metabolic dysfunction, including insulin resistance syndromes, dyslipidemia, and lipodystrophy. The association between ARTs and the risk of developing diabetes therefore calls for a careful choice of medication and evaluation of the risk of developing diabetes.
KeywordsHIV infection Diabetes Anti-retroviral treatment Complications
Compliance with Ethical Standards
Conflict of Interest
Emile Camille Noubissi, Jean-Claude Katte, and Eugene Sobngwi declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.DeFronzo RA, Ferrannini E, Alberti KGMM, Zimmet P. International textbook of diabetes mellitus, 4th ed. Chichester, West Sussex ; Hoboken, NJ: John Wiley & Sons Inc; 2015.Google Scholar
- 2.International Diabetes Federation. IDF diabetes atlas. 8th edn. Brussels, Belgium: International Diabetes Federation; 2017.Google Scholar
- 3.Joint United Nations Programme on HIV/AIDS (UNAIDS). 2017. http://www.unaids.org/en/resources/documents/2017/2017_data_book.
- 4.•• Atun R, Davies JI, Gale EAM, Bärnighausen T, Beran D, Kengne AP, et al. Diabetes in sub-Saharan Africa: from clinical care to health policy. Lancet Diabetes Endocrinol. 2017;5(8):622–67. This study showcases broadly the epidemiological profile of diabetes in sub-Saharan Africa and the contribution of HIV and ART towards the surge of diabetes prevalence in SSA. CrossRefGoogle Scholar
- 5.• Pepin ME, Padgett LE, McDowell RE, Burg AR, Brahma MK, Holleman C, et al. Antiretroviral therapy potentiates high-fat diet induced obesity and glucose intolerance. Mol Metab. 2018;12:48–61. This study proposes a possible mechanism for the development of obesity and glucose intolerance (major risk factor for diabetes) during Protease Inhibitor-based HIV regimen. CrossRefGoogle Scholar
- 18.• Hernandez-Romieu AC, Garg S, Rosenberg ES, Thompson-Paul AM, Skarbinski J. Is diabetes prevalence higher among HIV-infected individuals compared with the general population? Evidence from MMP and NHANES 2009–2010. BMJ Open Diabetes Res Care. 2017;5(1):e000304. This study demonstrates that the risk of developing diabetes in an HIV-infected population is higher than that of the general population. CrossRefGoogle Scholar
- 34.Williams RH, Larsen PR, éditeurs. Williams textbook of endocrinology. 10th ed. Philadelphia, Pa: Saunders; 2003. 1927 p.Google Scholar
- 43.Dolutegravir | FDA Label - Tablet (film coated) | AIDSinfo [Internet]. [cited 2018 Jul 31]. Available from: https://aidsinfo.nih.gov/drugs/509/dolutegravir/167/professional.
- 51.ONGLYZA® (saxagliptin) | Adult Type 2 Diabetes Medication [Internet]. [cited 2018 Jul 31]. Available from: https://www.onglyza.com/.
- 53.INVOKANA® (canagliflozin) Dosing & Prescribing Information [Internet]. [cited 2018 Jul 31]. Available from: https://www.invokanahcp.com/dosing.