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Multicenter Study
. 2024 Nov 15;38(14):1922-1931.
doi: 10.1097/QAD.0000000000003978. Epub 2024 Jul 18.

The impact of diabetes mellitus on HIV virologic control: results of the MACS/WIHS combined cohort study

Sarah C Mann  1 , Weiqun Tong  2 , Alison G Abraham  1 , Frank Palella  3 , Anjali Sharma  4 , Phyllis C Tien  5 , Margaret A Fischl  6 , Samy I McFarlane  7 , Cecile D Lahiri  8 , Susan Koletar  9 , Daniel Merenstein  10 , Michelle Floris-Moore  11 , Jordan E Lake  12 , Elizabeth Daubert  13 , Aubri Hickman  14 , Todd T Brown  2 , Jose Castillo-Mancilla  1   15
Affiliations
Multicenter Study

The impact of diabetes mellitus on HIV virologic control: results of the MACS/WIHS combined cohort study

Sarah C Mann et al. AIDS. .

Abstract

Objective: Diabetes mellitus (DM) is associated with lower antiretroviral (ART) drug exposure among persons with HIV (PWH) compared to PWH without DM. The association between DM and virologic control in PWH, however, remains unknown.

Methods: We included participants in the Multicenter AIDS Cohort Study/Women's Interagency HIV Study Combined Cohort Study (MWCCS) who had initiated ART between 1999 and 2020 and had a suppressed HIV viral load (≤200 copies/ml) within 1 year of ART initiation. We compared the frequency of incident HIV viremia (HIV-1 RNA >200 copies/ml) between adult PWH with and without DM. Poisson regression was used to examine the rate of incident viremia based on the diagnosis of DM among PWH. DM was defined as two consecutive fasting glucose measurements ≥126 mg/dl, use of antidiabetic medications, preexisting DM diagnosis, or a confirmed HbA1c >6.5%.

Results: 1061 women (112 with DM, 949 without DM) and 633 men (41 with DM, and 592 without DM) were included in the analysis. The relative rate (RR) of incident HIV viremia for women with HIV and DM was lower when compared to women without DM (0.85 [95% CI: 0.72-0.99]; P = 0.04). The RR of incident viremia for women with uncontrolled DM (HbA1c > 7.5%) was higher when compared to women with controlled DM (HbA1c < 7.5%) (1.46 [95% CI: 1.03-2.07]; P = 0.03). In contrast, the RR of incident viremia for men with HIV and DM was not statistically different compared to men without DM (1.2 [95% CI: 0.96-1.50]; P = 0.12). The results were stratified by adherence levels (100%, 95-99%, and <95% based on self-report).

Conclusions: Women with DM who are highly adherent to ART (100% self-reported adherence) have a lower risk of viremia compared to women with HIV without DM. However, women with poorly controlled DM were at higher risk of HIV viremia than women with controlled DM. Further research is necessary to understand the impact of sex, DM, and ART adherence on HIV viremia.

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Conflict of interest statement

Interests. JCM is an employee of ViiV Healthcare and has received research support from Gilead Sciences paid to his institution. SCM has received research support from Gilead Sciences paid to her institution. Other authors report no potential conflicts of interest. All authors have completed and submitted an ICMJE Form for Disclosure of Potential Conflicts of Interest.

Figures

Figure 1:
Figure 1:
Participant Inclusion Flow Diagram
Figure 2:
Figure 2:
Cumulative Incidence of Viremia
Figure 3:
Figure 3:
Viremia incidence by Adherence Level
See this image and copyright information in PMC

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