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Abstract

The purpose of this study was to exam the impact of type 2 diabetes mellitus (T2DM) on CD4 cell count trends in adults with HIV. In a longitudinal retrospective study in an urban primary care HIV clinic in the southeastern United States from 2010 to 2012, patients with HIV medical charts were audited to obtain their CD4 cell count, diabetes status, weight, and demographic information. Rates of increase of CD4 T cell count (i.e. slopes) were obtained using a linear mixed-effects model. Most of the HIV–T2DM cohort (n = 262) and HIV-only cohort (n = 2399) were African American (76%) and male (77%). The CD4 T cell counts were consistently higher in the HIV–T2DM cohort (p < .0001). The mean rate of CD4 T cell count increase (mean ± SE) was 63 ± 9 cells/µl/year in HIV–T2DM African American women and 28 ± 7 cells/µl/year in HIV–T2DM African American men (p = 0.003). In the multivariable slope analysis, the CD4 T cell count increase was significantly faster for HIV–T2DM African American women than for all other patients (mean difference = 30/cells/µl/year, 95% CI: 13–47; p < 0.001). Gender, race/ethnicity, and the diagnosis of diabetes influenced the recovery of CD4 cell counts.

Keywords

HIV diabetes mellitus CD4

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References

Harrison

Song

Zhang

. Life expectancy after HIV diagnosis based on national HIV surveillance data from 25 states, United States. J Acquir Immune Defic Syndr 2010; 53: 124–130.

Vance

Mugavero

Willig

et al.

Aging with HIV: a cross-sectional study of comorbidity prevalence and clinical characteristics across decades of life. J Assoc Nurses AIDS Care 2011; 22: 17–25.

Rolls

Denneny

Marcus

et al.

Tackling cardiovascular co-morbidities in HIV-positive patients: who, how and where?

J Int AIDS Soc 2014; 17: 19725–19725.

Brown

Tassiopoulos

Bosch

et al.

Association between systemic inflammation and incident diabetes in HIV-infected patients after initiation of antiretroviral therapy. Diabetes Care 2010; 33: 2244–2249.

De Wit

et al.

Incidence and risk factors for new-onset diabetes in HIV-infected patients the data collection on adverse events of anti-HIV drugs (D: A: D) study. Diabetes Care 2008; 31: 1224–1229.

Butt

et al.

HIV infection and the risk of diabetes mellitus. AIDS 2009; 23: 1227–1227.

White

. Mitochondrial toxicity and HIV therapy. Sex Transm Infect 2001; 77: 158–173.

Mitra S, El Atrouni W, Olotu B, et al. Diabetes, mortality, and the burden of comorbidities in people living with HIV (PLHIV), and the effect of exposure to protease inhibitors: a single-center study in the Midwestern united states. Open Forum Infect Dis 2016; 3(suppl 1): 2141.

Nix

Tien

. Metabolic syndrome, diabetes, and cardiovascular risk in HIV. Curr HIV/AIDS Rep 2014; 11: 271–278.

10.

Decrion

Dichamp

Varin

et al.

HIV and inflammation. Curr HIV Res 2005; 3: 243–259.

11.

Appay

Sauce

. Immune activation and inflammation in HIV-1 infection: causes and consequences. J Pathol 2008; 214: 231–241.

12.

Weisberg

et al.

Obesity is associated with macrophage accumulation in adipose tissue. J Clin Invest 2003; 112: 1796–1808.

13.

Wellen

Hotamisligil

. Inflammation, stress, and diabetes. J Clin Invest 2005; 115: 1111–1119.

14.

Geerlings

Hoepelman

AIM

. Immune dysfunction in patients with diabetes mellitus (DM). FEMS Immunol Med Microbiol 1999; 26: 259–265.

15.

Nikolajczyk

et al.

State of the union between metabolism and the immune system in type 2 diabetes. Genes Immun 2011; 12: 239–250.

16.

Mellors

et al.

Plasma viral load and CD4+ lymphocytes as prognostic markers of HIV-1 infection. Ann Intern Med 1997; 126: 946–954.

17.

Greub

Ledergerber

Battegay

et al.

Clinical progression, survival, and immune recovery during antiretroviral therapy in patients with HIV-1 and hepatitis C virus coinfection: the Swiss HIV Cohort Study. Lancet 2000; 356: 1800–1805.

18.

Tillmann

Heiken

Knapik-Botor

et al.

Infection with GB virus C and reduced mortality among HIV-infected patients. N Engl J Med 2001; 345: 715–724.

19.

Xiang

Wunschmann

Diekema

et al.

Effect of coinfection with GB virus C on survival among patients with HIV infection. N Engl J Med 2001; 345: 707–714.

20.

Koethe

et al.

Body mass index and early CD4 T-cell recovery among adults initiating antiretroviral therapy in North America, 1998–2010. HIV Med 2015; 16: 572–577.

21.

Koethe

et al.

An optimal body mass index range associated with improved immune reconstitution among HIV-infected adults initiating antiretroviral therapy. Clin Infect Dis 2011; 53: 952–960.

22.

Koethe

et al.

Higher time-updated body mass index: association with improved CD4+ cell recovery on HIV treatment. J Acquir Immune Defic Syndr 2016; 73: 197–204.

23.

Narayan

et al.

Effect of BMI on lifetime risk for diabetes in the US. Diabetes Care 2007; 30: 1562–1566.

24.

Geerlings

Hoepelman

. Immune dysfunction in patients with diabetes mellitus (DM). FEMS Immunol Med Microbiol 1999; 26: 259–265.

25.

Ledergerber

et al.

Factors associated with the incidence of type 2 diabetes mellitus in HIV-infected participants in the Swiss HIV Cohort Study. Clin Infect Dis 2007; 45: 111–119.

26.

Benesch

et al.

Inaccuracy of the international classification of diseases (ICD-9-CM) in identifying the diagnosis of ischemic cerebrovascular disease. Neurology 1997; 49: 660–664.

27.

Diggle PJ, Liang KY and Zeger SL. Analysis of longitudinal data. Oxford: Clarendon Press, 1994, pp. 68–69.

28.

Centers for Disease Control and Prevention. Rate per 100 of civilian, noninstitutionalized population with diagnosed diabetes, by age, United States, 1980–2011, http://www.cdc.gov/diabetes/statistics/prev/national/figbyage.htm (accessed 16 September 2014).

29.

Center for Disease Control and Prevention. Age-adjusted rate per 100 of civilian, noninstitutionalized population with diagnosed diabetes, by race and sex, United States, 1980–2011, http://www.cdc.gov/diabetes/statistics/prev/national/figraceethsex.htm (accessed 25 September 2015).

30.

Moyo

Tanthuma

Cary

et al.

Cohort study of diabetes in HIV-infected adult patients: evaluating the effect of diabetes mellitus on immune reconstitution. Diabetes Res Clin Pract 2014; 103: e34–e36.

31.

Abioye

Soipe

Salako

et al.

Are there differences in disease progression and mortality among male and female HIV patients on antiretroviral therapy? A meta-analysis of observational cohorts. AIDS Care 2015; 27: 1468–1486.

32.

AIDSinfo Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents, http://aidsinfo.nih.gov/guidelines (accessed 21 June 2016).

33.

Barclay

Hinkin

Castellon

et al.

Age-associated predictors of medication adherence in HIV-positive adults: health beliefs, self-efficacy, and neurocognitive status. Health Psychol 2007; 26: 40–49.

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The impact of diabetes on CD4 recovery in persons with HIV in an urban clinic in the United States

Abstract

Keywords

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Supplementary Material