The effect of HIV infection on glycaemic control and renal function in type 2 diabetic patients

Abstract

Background: Infection with, and treatment of HIV is associated with effects on glycaemia and renal function. The purpose of this study was therefore to compare glycaemic control and renal function in HIV-positive and HIV-negative type 2 diabetic patients. Methods: Diabetic patients with and without HIV infection were recruited from a diabetic clinic at Chris Hani Baragwanath Academic Hospital in Soweto, South Africa. Data were collected on weight, height, HbA I c, fasting glucose, urine albumin: creatinine ratio, HIV status, CD4 counts, viral load and concomitant therapies. Multivariable regression analysis was used to isolate the determinants of fasting glucose and HbA I c levels and risk factors for albuminuria. Results: Data were collected from I 06 HIV-positive and 214 HIV-negative diabetics. All HIV-infected subjects were receiving anti-retroviral therapy. The determinants of fasting glucose levels (log) were HIV infection (f3=0.04, p=0.01) and use of anti-hypertensive agents (f3=0.07, p=0.0006), whilst for HbA I c levels (log) they were HIV infection (f3=-0.03, p- 0.03 ), BMJ (f3=0.004, p=0.0005), statin use (P=0.04, p=0.002) and glucose levels (f3=0.01, p<0.0005). In HIV-positive subjects, CD4 counts were negatively associated with glucose levels (P=-0.0002, Jr-0.03). The risk factors for albuminuria were (odds ratio (95% Cis]) dyslipidaemia (1.94 (1.09, 3.44], p=0.02) and HbAlc levels (1.24 [1.12, 1.38], p<0.0001). Conclusions: These data suggest that glycaemic control is poorer in type 2 diabetic subjects with HIV infection and HbA I c underestimate glycaemia in these patients. Albuminuria was not associated with HIV positivity. The improved immunological function would seem to enhance glycaemic control in diabetic subjects with HIV. Statins and anti-hypertensive therapy were associated with worse glycaemic control suggesting that care should be taken when choosing from among such agents for use in subjects with type 2 diabetes.