In persons living with HIV and diabetes, the management of diabetes is lagging behind the evidence. Despite SGLT-2 inhibitors demonstrating robust clinical data in the general population, they are grossly underused in persons with HIV and diabetes.
Diabetes presents a significant health challenge for people living with HIV. Among persons with HIV, the prevalence of diabetes is over 2-fold higher than in individuals without HIV. There is also an earlier onset of diabetes among persons with HIV than in those without HIV. Diabetes is associated with a variety of macrovascular and microvascular effects, including cardiovascular disease (CVD), neuropathy, nephropathy, and retinopathy. Diabetes is particularly concerning for persons with HIV, as there is an additive effect on atherosclerosis, inflammation, and endothelial function. Further, HIV itself is associated with an increased risk of CVD, and diabetes adds to this risk.
There are other issues that need to be considered in persons with HIV and diabetes, such as accelerated aging, immune impairment, medication regimen complexity, and adherence challenges. There is a need to explore the use of newer glucoselowering medications with known benefits on CVD outcomes in persons with both HIV and diabetes. This is especially important given the potential interaction between select integrase strand transfer inhibitors—the most commonly used antiretroviral treatment (ART) anchor to treat HIV—and metformin. In addition, weight gain associated with sulfonylureas may additively elevate the overall CVD risk. The sodium-glucose cotransporter-2 (SGLT-2) inhibitors are a class of medications that have demonstrated robust activity in reducing hemoglobin A1C (HbA1C) levels as well as improving important cardiorenal outcomes that are worsened by diabetes across broad populations, including those with chronic kidney disease (CKD) and heart failure (HF).
Source : Contagion Live
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