High Prevalence of Prediabetes in a HIV Clinic of an Underserved Area

Presentation Number: MON 623
Date of Presentation: April 3rd, 2017

Dimpi Desai*, Paula Monzon Debroy, Orlando Quintero, Isaac Laniado and Jason Leider
Jacobi Medical Center & Albert Einstein College of Medicine, Bronx, NY

Abstract

Although the relationship of glucose metabolism abnormalities and obesity in human immunodeficiency virus (HIV) infected patients has been well described, there is little data of the burden of disease in this population. As chronic diseases continue to rise in the HIV population, identification of modifiable risk factors becomes more relevant. The aim of this study was to determine the prevalence of Prediabetes in a cohort of HIV infected patients in an underserved area and the metabolic factors associated with it.Medical charts of patients who attended an adult HIV outpatient clinic in the Bronx during the year 2014 were reviewed for demographic and clinical data. Prediabetes was defined using established ADA Hemoglobin A1c criteria. Obesity was characterized according to Body mass index (BMI) as: normal weight (18.5-24.9), overweight (25-29.9), obese (30-39.9), and morbidly obese (≥40).A total of 1180 patients were included. The median age was 49.5 years (range, 18-82); 50.7% were female. Most of the patients were African American (48.1%) and Hispanic (42.9%). The median CD4 count was 566 cells/ mm3 (IQR 360-804). A total of 92% were receiving anti-retroviral therapy (ART) with a median duration of 11 years (IQR 6-16); 82.6% were virally suppressed. Hepatitis C co-infection was present in 176 (14.9%) patients. The prevalence of prediabetes was 24.9%. Overall, 402 (34.1%) patients had normal weight, 383 (32.5%) were overweight, 317 (27.1%) were obese, and 69 (5.8%) were morbidly obese. In patients with normal weight, the prevalence of prediabetes and diabetes were 19.3% and 7.3% respectively; in overweight 27.2% and 12.5%; in obese, 26.5% and 19.2% and in morbidly obese, 37.7% and 26.1%. There was a significant difference between BMI classification and both the presence of pre-diabetes (p<0.0005) and diabetes (p<0.000). A total of 40% obese patients and 38% morbidly obese patients were on protease inhibitor (PI) based regimens. There was no statistical significant association between BMI classification and PI based ART regimen. Diagnosis of hypertension was present in 24% patients with a normal BMI, in 29% of overweight, in 41% of obese, and in 53% of morbidly obese patients. Diagnosis of hyperlipidemia was present in 18% of patients with normal weight, in 25.6% of overweight, in 29.3% of obese, and in 40.6% of morbidly obese patients. There was a concomitant diagnosis of hypertension, hyperlipidemia, and impaired glucose tolerance in 136 (11.5%) patients.There is a high prevalence of prediabetes in this cohort of HIV patients. More than half the patients were overweight or obese, with higher risk for having both prediabetes and diabetes as well as coexisting hypertension and hyperlipidemia. Identification of individuals at risk for glycemic abnormalities, including those with an abnormal BMI, is an important target for intervention.

 

Nothing to Disclose: DD, PMD, OQ, IL, JL