Could Antiretroviral Therapy for HIV Increase Diabetes Risk?

HIV and antiretroviral therapy (ART) were suggested to be linked to the development of diabetes and hypertension in people living with HIV (PLHIV), according to the findings of a recent literature review.

The authors reviewed existing studies that reported on the rates of diabetes and hypertension and metabolic changes caused by HIV infection in PLHIV, as well as studies that examined adverse events associated with both comorbidities in relation to ART use.
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Incidence and prevalence of type 2 diabetes was found to be higher in PLHIV on ART compared with the HIV-negative population, according to the authors. They reported that HIV infections were found to trigger inflammatory responses that resulted in insulin resistance, which was suspected to increase the risk for type 2 diabetes. However, the authors found conflicting evidence that showed a need for additional research before any conclusions on the direct or indirect relationship between HIV and diabetes could made.

Likewise, ART was implicated in metabolic changes in the body that could lead to the development of diabetes, such as insulin resistance, dyslipidemia, and altered fat distribution. In addition, the risk for metabolic syndrome was associated with several, if not all, ART regimens, in multiple studies. The authors’ findings indicated that the risk for metabolic syndrome remained high for PLHIV despite treatment, and might even be exacerbated by ART use.

“Therefore, even with reviewed ART regimes, the need to monitor patients on ART for development of diabetes cannot be over emphasized, particularly in the era of universal ART access,” the researchers wrote.

Hypertension was suggested to be linked to HIV-caused changes in triglycerides, T-cells and angiotensin II, as well as the aggressive use of ART. Further, ART was found to be associated with increases in blood pressure, and successful HIV treatment did not completely mitigate the pro-inflammatory response that causes hypertension, according to the authors.

“Notwithstanding the contrasting research reports on the link between HIV, hypertension and [diabetes], hypertension and [diabetes] among PLHIV is a cause for concern, and there is a need for more studies, particularly in areas most hit by HIV,” the researchers concluded.

—Melissa Weiss

Reference:

Maseko TSB and Masuku SKS. The effect of HIV and Art on the development of hypertension and type 2 diabetes mellitus [published online March 20, 2017]. J Diabetes Metab. doi:10.4172/2155-6156.1000732.