The Association Between Hiv Tri
Roles Conceptualization, Data curation, Investigation, Methodology, Project administration, Writing original draft, Writing review & editing
Affiliation Department of Nursing, Walter Sisulu University, Mthatha, South Africa
Roles Supervision, Writing review & editing
Affiliation Department of Nursing, Walter Sisulu University, Mthatha, South Africa
Roles Funding acquisition, Resources, Writing review & editing
Affiliation Department of Laboratory Medicine, Walter Sisulu University, Mthatha, South Africa
Roles Project administration, Writing review & editing
Affiliation Department of Public Health, Walter Sisulu University, Mthatha, South Africa
Effects Of Hiv On Glucose Homeostasis
Early articles reported that clinically stable, symptomatic HIV-infectedmen who were subjects in euglycemic clamp studies had higher rates of insulinclearance and increased insulin sensitivity in peripheral tissues comparedwith the noninfected controlgroup. The increasein noninsulin-mediated glucose uptake seen in those infected with HIVhas been accounted for by an increase in nonoxidative glucosedisposal.Glucose production from the liver tends to increase, but glucose cycling doesnotchange.,Although there are many studies linking the use of protease inhibitors to the development of insulin resistance, there is also evidence suggestingthat insulin resistance may have an HIV diseaseassociated component aswell.
How Do You Decide What To Take
Even though these medicines can raise your blood sugar, it doesnât mean that you shouldnât take them if you need them. The most important thing is to work with your doctor on the right way to use them.
Make sure your doctor knows all the medicines you take — for diabetes or any other reason. If one of them may affect your blood sugar, they may prescribe a lower dose or tell you to take the medicine for a shorter time. You may need to check your blood sugar more often while youâre taking the medicine, too.
Also, remember to do the things you know will help keep your levels under control. Exercise, eat right, and take any diabetes medicines that you need.
American Diabetes Association: âFactors Affecting Blood Glucose.â
CDC: Basics About Diabetes, âWhat is diabetes?â
Diatribe: âHow many factors actually affect blood glucose?â
Diabetes Forecast: âMedications That Raise Blood Glucose,â âOver-the-Counter Meds that Raise Blood Sugar.â
NPS Medicinewise: âMedicines that affect blood glucose levels in type 2 diabetes.â
National Institutes of Health AIDS info: âHIV and Diabetes.â
UIC Center on Psychiatric Disability and Co-Occurring Medical Conditions: âPsychiatric Meds & Diabetes.â
Mayo Clinic: âNiacin .â
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Diabetes In People Living With Hiv
Rates of diabetes are higher in people living with HIV than in the general population. One important reason is that many people living with HIV have some of the risk factors for diabetes mentioned above.
Chronic inflammation in response to HIV infection may also raise the risk of diabetes. This dysfunctional response of the immune system can harm organs and body systems. HIV treatment and a healthy lifestyle help reduce inflammation but cant completely eliminate it.
“The first line of treatment is to devise a healthy eating and physical activity plan to help reduce body weight that, if successful, will bring diabetes under control.”
Some anti-HIV medications may contribute to diabetes risk. They include older nucleoside reverse transcriptase inhibitors and older protease inhibitors . These drugs are not generally used today but you may have taken them in the past.
Some newer treatments including integrase inhibitors have been associated with weight gain, although the reasons for this remain unclear. Its generally the case that weight gain increases the risk of developing diabetes, but it is not yet clear if the weight gain linked with integrase inhibitors does so.
A1c Underestimates Glycemia In Hiv Infection
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Can Hiv Medicines Cause Side Effects
HIV medicines help people with HIV live longer, healthier lives. HIV medicines also reduce the risk of HIV transmission. But HIV medicines can sometimes cause side effects. Most side effects from HIV medicines are manageable, but a few can be serious.
Overall, the benefits of HIV medicines far outweigh the risk of side effects. In addition, newer HIV medicines cause fewer side effects than medicines used in the past. As HIV treatment continues to improve, people are less likely to have side effects from HIV medicines.
Before starting HIV medicines, people with HIV discuss possible side effects from HIV medicines with their health care providers. They work together to select an HIV regimen based on the persons individual needs.
Corticosteroids To Lower Inflammation In Arthritis Asthma Allergies And Joint Injuries
These drugs are used to treat many conditions associated with inflammation, including arthritis, asthma, allergies, and joint injuries. Corticosteroids used in inhalers or skin creams arent likely to affect blood glucose because they dont enter the blood stream in great enough quantities. But those that are injected or ingested by mouth can significantly increase blood glucose, says Timothy In-Chhu Hsieh, MD, chief endocrinologist at the Kaiser Permanente West Los Angeles Medical Center in California.
“If it’s only a short-term treatment, there won’t be too long of an effect and it may not influence things a great deal, but if it’s being used for several days or weeks, then the sugar level can go higher and be a significant problem,” he says. If thats the case, you can work with your doctor to adjust your diabetes medication to keep glucose under control.
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Data From The Women’s Interagency Hiv Study
The Women’s Interagency HIV Study , established in 1994, is a large study based in six U.S. cities that tracks the disease progression of women with and at risk for HIV using semi-annual study visits. Data regarding diabetes was published at three different time points, with increasingly detailed information each time.
One such study, by Jessica Justman, MD, of Columbia University’s HIV Center for Clinical and Behavioral Studies and colleagues, examined the incidence of diabetes in the WIHS group from 1994 to 1998. Participants included 1,435 women living with HIV and 350 HIV negative women. The investigators compared women in three groups: those who used PIs in a regimen containing one PI and at least one NRTI and/or NNRTI, those who used NRTIs and/or NNRTIs but no PIs, and those who received no antiretroviral therapy at all.
Sixty-nine new cases of diabetes were reported among all study participants, for an incidence of 1.5 per 100 PY overall. Breaking down the incidence by HIV status and antiretroviral therapy group, the incidence of diabetes in women without HIV was 1.4 per 100 PY, incidence among women using NRTIs and/or NNRTIs was 1.2 per 100 PY, and incidence in HIV positive women not taking antiretroviral therapy was also 1.2 per 100 PY. The incidence of diabetes was highest in women taking PIs, at 2.8 per 100 PY — a statistically significant difference. The authors also noted that the highest risk of developing diabetes occurred among women who were obese.
Diabetes Mellitus In Hiv And Aging
- The most important prevention for adult onset diabetes mellitus is to avoid excess weight gain. Since most patients living with HIV come into care at or below normal weight, patients initiating ART should be encouraged to avoid excess weight gain.
- Screening for diabetes should be done regularly, before and after the initiation of ART, using glycosylated hemoglobin with appropriate follow up. For patients with diabetes, hemoglobin should be checked at least twice yearly.
- The target glycosylated hemoglobin should be 8% for frail patients, especially if their life expectancy is less than 5 years, are at high risk for hypoglycemia, polypharmacy or drug interactions.
- Management and treatment of diabetes mellitus and its complications should be done according to established guidelines.
Morphologic changes are common in older patients living with HIV/AIDS. Increasing age is risk factor for loss of subcutaneous fat and/or increase in central fat deposition but newer ART regimens are less likely to promote these changes. Older patients should be switched from thymidine analogues to INSTIs which are less likely to cause direct metabolic pertubations that may lead to morphologic changes. Treatment options for patients with lipohypertrophy can include surgical removal of fat or use of growth hormone releasing factor.
Treatment of Diabetes Mellitus
Assessment and Treatment of Complications of Diabetes
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Strategies To Manage Hyperglycemia
Guidelines for management of diabetes in the OPD set up have been discussed in detail elsewhere. However, these do not focus on HIV-associated diabetes.
Management strategies for diabetes are somewhat different in HIV patients than in the general population. The unique features of diabetes management in HIV are listed and discussed below:
Physical Causes Of Erectile Dysfunction In Men With Hiv
In addition to the factors mentioned above, there are specific factors that are important if you are living with HIV. These include having lived with HIV for a longer time, a lower CD4 cell count when you were first diagnosed and possibly taking certain HIV medications . If you have both HIV and hepatitis C, or suffer from body fat redistribution , you may be more likely to have difficulties getting an erection.
Many men with HIV have low testosterone levels . This can be difficult to diagnose because some symptoms are less specific and can occur in men with HIV who have normal testosterone levels. It is important for your doctor to investigate whether this could be the cause of your impotence. Chronic illness, HIV replication, antiretroviral medications, lipodystrophy, metabolic syndrome, other co-morbidities and co-infections can contribute to low testosterone levels in people living with HIV.
A substance that acts against retroviruses such as HIV. There are several classes of antiretrovirals, which are defined by what step of viral replication they target: nucleoside reverse transcriptase inhibitors non-nucleoside reverse transcriptase inhibitors protease inhibitors entry inhibitors integrase inhibitors.
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Research Design And Methods
A total of 100 HIV-infected adults with type 2 diabetes or hyperglycemia participated between March 2007 and March 2008. Patients who were pregnant or had hemoglobinopathy, recent changes in antiretroviral or diabetes therapy, anemia, opportunistic infection, renal disease, creatinine > 1.8 mg/dl, a recent blood transfusion, or corticosteroid use were excluded. All participants gave written informed consent.
Sex-, race-, and age-matched HIV-uninfected type 2 diabetic control subjects were obtained from MedStar Health’s electronic medical record system. Except for HIV factors, exclusion criteria were the same. Random serum glucose and A1C measurements were obtained. This study was approved by the National Institute of Allergy and Infectious Diseases and MedStar institutional review boards.
Measurements included fasting and nonfasting plasma and serum glucose, fructosamine and A1C, and haptoglobin, albumin, HIV viral load, and CD4 counts. Glucose was determined on a Synchron LX20 , A1C was determined by ion-exchange high-performance liquid chromatography on a Variant Hemoglobin Testing System , and fructosamine was determined by Esoterix laboratory services . Analyses for control subjects were completed at MedStar laboratories, and A1C was determined by HPLC on a Tosoh HLC-723 GHbG7 at Washington Hospital Center. There is documented good agreement between Tosoh HLC-723 and Bio-Rad Variant systems .
Hiv And Diabetes: Minimising Risk For People Living With Hiv
Coping with HIV is challenging enough for anyone, but the risk of acquiring Diabetes must not be forgotten. Any virus or bacteria is likely to affect your bodys immune system. This affects how your body copes with other health threats, either from the same condition or other trauma.
While its possible to find a lot of information online about improving your health, remember that no two people are the same. This makes it worth your while to learn more about your own body: never pass up the chance to ask your doctor questions. You may learn fascinating things about why youve been given specific medicines, and why those may change over time.
With regards to cardiovascular health, HIV-related conditions usually receive more attention. Even though this is the norm, were here to unpack why your risk of developing Diabetes is higher if youre HIV-positive. Tailoring lifestyle changes and nutritional plans with the help of a medical expert is beneficial in many ways. There are a number of factors that may influence your plan: viral load overall immune strength pre-Diabetic symptoms cholesterol blood pressure and others like resource access and availability of funds.
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Hiv Is ‘like Diabetes’ Let’s Stop Kidding Ourselves
Journalist and Author of Victory Deferred, Hot Stuff, Wilhelmina Goes Wandering, and, out this October, Stonewall Strong
My antenna perked up when I read a gay man’s comment that HIV infection is essentially no big deal anymore. “It’s like diabetes these days,” he said. As an HIV-positive 53-year-old, familiar with the health details of some near and dear diabetics, and having just written an article about the type-2 diabetes epidemic, I’d say this: we need to choose our analogies carefully.
We need to banish the notion that HIV infection today is “like diabetes,” in spite of their similarities. Consider:
But beyond this, and in spite of the obvious differences between a viral disease and a metabolic one, the most striking difference between having HIV and type-2 diabetes today is this: There’s not even a remote chance that changing my diet or exercise habits can cure what I have.
Paradigm Shifts In Cart
Recently, global efforts have focussed on increasing access to and early initiation of cART to prevent AIDS-related deaths and HIV transmission . Over the last 10 years, the World Health Organisation has recommended earlier cART-initiation based on CD4+ T-lymphocyte counts falling below progressively higher thresholds: 200 cells/L in 2006 , 350 cells/L in 2009 , and 500 cells/L in 2013 . Global strategies to eradicate HIV transmission led the WHO in 2015 to recommend cART-initiation at HIV diagnosis regardless of CD4+ T-lymphocyte counts . Further, UNAIDS launched the 90-90-90 targets in 2014 aiming to end the AIDS epidemic by 2030: 90% of people living with HIV-infection knowing their status, 90% receiving sustained cART and 90% of cART-recipients achieving viral suppression by 2020 . It is estimated that if these targets are met by 2020, the number of cART-recipients worldwide would increase from 20.9 million to 30 million .
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Managing The Risk Of Diabetes When Living With Hiv: A Dieticians Advice
Clinical Dieticians are qualified to create individualised plans for each and every patient. Usually, to effectively manage the risk of Diabetes, reduced energy intake and increased physical activity work hand in hand. Because everyones bodies react differently, it takes the insight of a qualified professional to help manage cravings, changes in appetite, and food group ratios, effectively enough to maintain a healthy immune system and reach other health goals.
Dieticians, however, can be costly and difficult for many people to access. Moreover, meal plans can drive families into debt if not carefully managed and tailored to the exact needs and capacity of each patient. In lieu of the ability to consult with a professional Clinical Dietician, HIV-positive people can consult with doctors, clinic staff and other medical practitioners. Online resources can be helpful but its important to choose credible sites like this one from AllLife, to make sure that youre finding relevant, useful and accurate information about your experience of HIV and/or Diabetes.
Decongestants Used To Offer Relief From The Common Cold Or Flu
Decongestant medicines, including Sudafed and phenylephrine, can increase your blood sugar levels. Both are available over the counter, although medication with pseudoephedrine has to be requested from a pharmacist. Many common decongestants use one of these ingredients, so check labels carefully. Short-term use of these is probably okay, but check with your doctor first.
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Your Lifestyle And Erectile Dysfunction
As cholesterol, high blood pressure, diabetes and other health conditions can all contribute to erectile dysfunction, lifestyle changes may help.
- Lose weight if you’re overweight.
- Exercise regularly: particularly activities that get the heart rate up, such as walking fast, dancing, gardening and cycling.
- Donât smoke.
Diabetes And Insulin Resistance
Type 1 diabetes is typically diagnosed in children and young adults. The disease is caused by destruction of the pancreatic islet beta cells, which produce insulin. People with type 1 diabetes therefore have a lifelong dependence on insulin therapy. Type 2 diabetes is usually diagnosed later in life, and is the result of tissue insensitivity to insulin. The pancreas overcompensates by increasing insulin secretion, but eventually it cannot keep up. More than 90% of the approximately 18 million known diabetics in the U.S. have type 2 diabetes.
The long-term consequences of uncontrolled diabetes are devastating. They include vascular disease and kidney disease , which may eventually lead to end-stage renal disease requiring dialysis. Diabetic retinopathy causes vision changes and eventually blindness, and diabetic neuropathy, which causes painful burning and tingling or numbness in the limbs, can be debilitating. Skin infections, especially of the feet, take longer to heal in diabetics than in non-diabetics, placing diabetics at higher risk for amputation.
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Ir And Coronary Stenosis In Hiv
An analysis of Multicenter AIDS Cohort Study data collected between 2003 and 2013 found IR to be more likely in men with HIV than in men without HIV , and to be associated with significant coronary artery stenosis in both groups. During the study, fasting serum insulin and glucose measurements were obtained semiannually during the 10-year period, and used to determine HOMA-IR, whereas computed tomographic angiography was performed at the end of the study to characterize coronary pathology. Compared with uninfected men, those with HIV had significantly higher HOMA-IR. When measured near the time of CTA, men with HIV had a HOMA-IR of 3.2 compared with 2.7 for uninfected men , and when HOMA-IR was averaged during the study period, they had a HOMA-IR of 3.4 compared with 3.0 for uninfected men . HOMA-IR was associated with greater odds of coronary stenosis of at least 50% in models comparing men with values in the highest vs the lowest tertiles, although the effect was not significantly modified by HIV serostatus.