title: Control of medical comorbidities in individuals with HIV.
abstract: BACKGROUND
  With improved combination antiretroviral therapy-related survival, diabetes and hypertension increasingly contribute to morbidity and mortality among individuals with HIV. However, there is limited data on diabetes and blood pressure control in this population. We examined whether virologic control is associated with control of diabetes and hypertension.
  
  
  METHODS
  We examined HIV viral load, hemoglobin A1c (HbA1c), and blood pressure measurements from 70 diabetics and 291 hypertensives in the Johns Hopkins HIV Clinical Cohort, an urban, university-based cohort. All patients were treated for HIV and diabetes or hypertension. HbA1c and HIV-1 RNA were captured electronically from laboratory data, and blood pressure was collected electronically from vital signs taken at clinic visits. We used HIV-1 RNA values within 30 days of the HbA1c measurement or blood pressure measurement. The relationships between HIV-1 RNA and HbA1c and HIV-1 RNA and blood pressure were examined using separate random effects generalized least squares linear regression models.
  
  
  RESULTS
  The study sample was predominantly male and black, with a high prevalence of comorbid hepatitis C virus infection and psychiatric illness. In multivariable analysis, each log(10) increase in HIV-1 RNA was associated with higher HbA1c (β = 0.47 units, P < 0.001) among diabetics and higher mean arterial pressure among hypertensive patients (β = 1.95 mmHg, P < 0.001).
  
  
  CONCLUSIONS
  Suboptimal control of HIV, indicated by detectable viral load, correlates with suboptimal control of diabetes and hypertension, indicated by higher HbA1c and mean arterial pressure. Achieving control of multiple medical comorbidities and HIV simultaneously may require expansion of current adherence interventions focused primarily on antiretroviral therapy.
authors.affiliation: Department of Medicine, Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA. amonroe4@jhmi.edu
authors.forename: Anne K
authors.initials: AK
authors.lastname: Monroe
authors.forename: Geetanjali
authors.initials: G
authors.lastname: Chander
authors.forename: Richard D
authors.initials: RD
authors.lastname: Moore
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D001794:Blood Pressure; D015331:Cohort Studies; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D015497:HIV-1 / Q000235:genetics; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000032:analysis; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents; D006442:Glycated Hemoglobin; D012367:RNA, Viral; C517652:hemoglobin A1c protein, human
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