HIV and Diabetes

What is diabetes?
Diabetes is a medical condition associated with high levels of sugar in the blood. The word diabetes literally means “sweet urine” because sugar (glucose) that cannot enter the body’s cells is then excreted in the urine. There are two forms of the disease, Type 1 and Type 2.

People with Type 1 diabetes have a problem metabolising sugar. This occurs when the pancreas is no longer able to produce the hormone insulin that controls the levels of glucose in the blood, leading to abnormally high levels of blood glucose.

People with a family history of Type 1 diabetes are at greater risk of developing the disease, which most commonly begins at around age 14, although onset can occur up to age 40. Symptoms include excessive thirst, weight loss, excessive urination and tiredness. Treatment involves insulin injections.

Type 2 diabetes is the more common form, and usually occurs in people over 30 . The affected person develops a resistance to insulin, resulting in high blood glucose levels. The high glucose levels contribute to kidney failure, eye problems and coronary artery disease (artherosclerosis). Artherosclerosis leads to strokes and heart disease.

Risk factors for Type 2 diabetes include obesity, especially where the belly or waistline is overly enlarged compared to the limbs, and lack of exercise. Treatment includes lifestyle changes such as weight loss and exercise, oral medications and sometimes insulin injections to lower blood glucose.

Diabetics are at risk of other medical problems and conditions, including hypertension and lipid abnormalities that can be treated with medication. Long-term complications can be avoided if blood glucose, blood pressure and lipid levels are controlled.

What is the relationship between HIV and diabetes?
Studies suggest that anti-retroviral therapy (ART) may cause diabetes in some HIV positive people.

The three drugs in the anti-retroviral drug “cocktail” are a protease inhibitor (PI) and two nucleoside reverse transcriptase inhibitors (RTIs). These drugs help stop the virus from replicating and spreading throughout the body. A study of HIV-positive patients suggests that the interaction of the three drugs in the cocktail causes fat to collect in the patient’s abdominal area, and is also responsible for weight loss in the arms, legs and face.

In addition, the drugs may interfere with certain proteins that are involved in controlling the body’s absorption of blood sugar and this could lead to the development of diabetes. ART is associated with insulin resistance, which is commonly the cause of Type 2 diabetes.

Studies show that five to twenty percent of patients on PI-based ART will develop insulin resistance and about one to five percent actually has diabetes.

How does HIV affect people who already have diabetes?
It is likely that people who already have diabetes and then go on ART may have greater difficulties in controlling their diabetes. This could lead to an increase in the risk of heart disease and other diabetes-related complications.

It is thought that patients who have both HIV and diabetes can continue to do well for many years, as long as they have access to good care and keep the diabetes under control by following a healthy diet and exercising regularly.