Study looks at the effect of diabetes on HIV virologic control

Women living with HIV who reported 100% adherence to their antiretroviral treatment and had diabetes were less likely to experience HIV viremia than women without diabetes, according to a recent study. However, a similar difference was not observed among men living with HIV.

About This Study

“The impact of diabetes mellitus on HIV virologic control: results of the MACS/WIHS combined cohort study” was published online on July 19, 2024, in AIDS. The lead author is Sarah C. Mann, M.D., of the University of Colorado Anschutz Medical Campus in Aurora, Colorado. One of the study authors also works for ViiV Healthcare, a manufacturer of HIV antiretrovirals.

Key Research Findings

This multicenter prospective study investigated incident HIV viremia by diabetes mellitus status in 1,061 women (112 with diabetes) and 633 men who have sex with men (41 with diabetes), all living with HIV, who were virally suppressed at baseline. Most women were Black (68% of those with and 64% of those without diabetes) while 55% of men without diabetes (vs. 44% of men with diabetes) were white. Participants with diabetes were older and had a higher body mass index than those without the condition.

Among women with self-reported 100% adherence to HIV treatment, incident viremia was less common in those with diabetes than those without that comorbidity. At lower adherence levels, there was no significant difference in viremia by diabetes status. However, poorly controlled diabetes was associated with higher rates of viremia in women even when they reported high antiretroviral treatment adherence. Among men, viremia was not associated with diabetes status at any HIV treatment adherence level.

While there was little difference in health behaviors among men with or without diabetes, women with diabetes were more likely to be adherent to their HIV treatment and have hypertension under control, and less likely to consume excessive alcohol or smoke currently than women without diabetes.

Discussion Highlights and Implications for Practice

Self-reported antiretroviral treatment adherence was high overall and most participants’ diabetes was well controlled, the researchers said. Another study limitation reported was that data on diabetes medication adherence, health care visit frequency, and glycemic status complications were not available. The population studied was small and heterosexual males were not included, limiting generalizability.

Prior research had found that diabetes was associated with lower antiretroviral exposure, the authors pointed out. However, in this study, differences in health behaviors, such as hypertension management and lower rates of smoking and binge drinking among women, but not men, may explain the finding that diabetes was associated with fewer, rather than more, HIV viremic episodes, they said.

However, the authors concluded that the possibility of sex-related differences should also be studied. Such research could lead to the development of women-specific diabetes prevention efforts that could be combined with HIV adherence counseling.

By Barbara Jungwirth