Predictors of glycaemic control among HIV-positive veterans with diabetes.
Antiretroviral therapy has decreased HIV-related mortality. However, the incidence of diabetes as a co-morbidity is increasing as HIV-positive patients age. The purpose of this study was to assess the correlation between markers of HIV-infection and diabetes and to determine the proportion of patients achieving an haemoglobin A1c (HbA1c) goal <7% according to specific antiretroviral therapy regimens and adherence. In this retrospective study, HIV-positive veterans with diabetes from 2007 to 2012 were identified. Patients were required to be on the same antiretroviral therapy and diabetes regimen for ≥3 months. In 56 patients, it was identified that for each unit increase in log10 viral load, HbA1c increased 0.67 units (p = 0.0085). Only 38% of patients prescribed a protease inhibitor-based regimen vs. 56% of patients not on a protease inhibitor-based regimen achieved an HbA1c goal (p = 0.1864). Additionally, patients on an insulin-based regimen and patients that were less adherent were less likely to be at HbA1c goal (p = 0.018 and p = 0.0378, respectively). Patients with higher viral loads and patients that were less adherent to antiretroviral therapy were more likely to have a higher HbA1c demonstrating that poor adherence to antiretroviral therapy leads to poor control of both disease states.
Durham VA Medical Center, Durham, NC, USA Mldavies0412@email.campbell.edu.
Marie L
ML
Davies
Campbell University College of Pharmacy & Health Sciences, NC, USA Duke University Medical Center, Durham, NC, USA.
Melissa D
MD
Johnson
Durham VA Medical Center, Durham, NC, USA.
Jamie N
JN
Brown
Durham VA Medical Center, Durham, NC, USA.
William E
WE
Bryan
Durham VA Medical Center, Durham, NC, USA Campbell University College of Pharmacy & Health Sciences, NC, USA.
Mary L
ML
Townsend
D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D001786:Blood Glucose / Q000032:analysis* / Q000378:metabolism; D018791:CD4 Lymphocyte Count; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000378:metabolism; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis* / Q000378:metabolism; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy; D015497:HIV-1 / Q000187:drug effects; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D011237:Predictive Value of Tests; D012367:RNA, Viral / Q000235:genetics; D012189:Retrospective Studies; D014481:United States; D014728:Veterans / Q000523:psychology* / Q000706:statistics & numerical data; D019562:Viral Load
D019380:Anti-HIV Agents; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D012367:RNA, Viral
AIDS; HIV; HbA1c; antiretroviral therapy; cardiovascular disease; diabetes; glycaemic control; haemoglobin A1c; insulin resistance; medication adherence