Home | About us | Editorial board | Search | Ahead of print | Current issue | Archives | Submit article | Instructions | Subscribe | Contacts | Advertise | Login 
 
Search Article 
  
Advanced search 
  Users Online: 47 Home Print this page Email this page Small font sizeDefault font sizeIncrease font size  

 
Table of Contents
LETTER TO THE EDITOR
Year : 2012  |  Volume : 16  |  Issue : 4  |  Page : 674-675

Diabetes in the time of HIV


Department of Internal Medicine, St John's Medical College, Sarjapur Road, Bangalore, Karnataka, India

Date of Web Publication5-Jul-2012

Correspondence Address:
Jyothi Idiculla
Associate Professor, Department of Internal Medicine, St John's Medical College, Sarjapur Road, Bangalore - 560034, Karnataka
India
Login to access the Email id


DOI: 10.4103/2230-8210.98052

Get Permissions


How to cite this article:
Idiculla J, Ravindran GD. Diabetes in the time of HIV. Indian J Endocr Metab 2012;16:674-5

How to cite this URL:
Idiculla J, Ravindran GD. Diabetes in the time of HIV. Indian J Endocr Metab [serial online] 2012 [cited 2014 Jul 24];16:674-5. Available from: http://www.ijem.in/text.asp?2012/16/4/674/98052

Sir,

It is indeed a welcome endeavor that "HIV and diabetes" is being projected in the October 2011 issue of the IJEM. [1]

In India, as per National Aids Control Organization (NACO) guidelines, protease inhibitors are considered when clinical, virological, or immunological failure occurs on first-line anti-retroviral therapy (ART). [2] Therefore, the statement "PI based regimens should be avoided in patients with a high risk of diabetes" (page 248, para 7) should be reviewed and revised. If a patient develops diabetes or glucose intolerance, this has to be dealt with appropriate measures as protease inhibitors form the backbone of second-line ART.

With reference to the choice of therapy, most of our patients with HIV are below the poverty line, and hence both insulin and Glucagon like peptide-1 (GLP-1) analogs will not be easily affordable options. Moreover, liraglutide (or exenatide) with concurrent usage of non-nucleoside reverse transcriptase inhibitors may pose a risk of pancreatitis. [2]

Dyslipidemia in HIV is well established and this has similarities with diabetic dyslipidemia. In diabetic patients with HIV, NCEP ATPI III recommendations to reduce total cholesterol levels to less than 160 mg/ dl, low density lipoprotein (LDL) to less than 100 mg/ dl, high density lipoprotein (HDL) to above 40 mg/dl in men and 50 mg/ dl in women should be advised and not the higher targets suggested by the authors. [3] While using statins, it is important to be aware of the risk of hepatic dysfunction and consequent death in HIV-infected individuals. [4] Physicians should also know that the occurrence of myopathy/rhabdomyolysis is high when protease inhibitors are used in conjunction with certain statins like simvastatin and lovastatin.

The authors have not alluded to the International Aids Society's guidelines on metabolic complications published in 2002 in the Journal of Acquired Immune Deficiency Syndromes for diabetes and lipid-related issues other than in the context of megestrol acetate usage. [5] The Asian guidelines should state issues of concern in our subset of HIV-infected patients, considering their propensity for metabolic syndrome and the ART regimes in use here. A summary sheet with screening intervals, indications, and criteria, therapeutic options, and red flags for immediate action (both for dysglycemia and dyslipidemia and associated conditions like hypertension and ischemic heart disease (IHD)) would be of immense help to primary care physicians.

Physicians and endocrinologists need to accept the chronicity of HIV infection as well as diabetes, and consider consequent social, economic, physical, and psychological implications while treating these patients. There is a paucity of ethically and systematically conducted longitudinal research work focusing on the risks of disease and the benefits and side effects of therapies. We need these to make precise and concise guidelines for these patients, constantly bearing in mind that a vast majority of them struggle to make a living and are unable to afford costly drugs which claim high benefits.

 
   References Top

1.Kalra S, Unnikrishnaan AG, Raza SA, Bantwal G, Baruah MP, Latt TS, et al. South Asian Consensus Guidelines for the rational management of diabetes in human immunodeficiency virus/ acquired immune deficiency syndrome. Indian J Endocrinol Metab 2011;15:242-50.  Back to cited text no. 1
    
2.Available from: http://www.nacoonline.org. [Last accessed on 2012 Feb 18].  Back to cited text no. 2
    
3.NCEP Expert Panel on Detection Evaluation and Treatment of High Blood cholesterol in adults (ATPIII) final report. Circulation 2002;106:3143-421.  Back to cited text no. 3
    
4.Towner WJ, Xu L, Leyden WA, Horberg MA, Chao CR, Tang B, et al. The Effect of HIV Infection, Immunodeficiency and antiretroviral therapy on the risk of hepatic dysfunction. J Acquir Immune Defic Syndr 2012. (Epub ahead of print)  Back to cited text no. 4
    
5.Schambelan M, Benson CA, Carr A, Currier JS, Dubé MP, Gerber JG, et al. Management of metabolic complications associated with antiretroviral therapy for HIV-1 infection: Recommendations of an International AIDS Society-USA panel. J Acquir Immune Defic Syndr 2002;31:257-75.  Back to cited text no. 5
    




 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    References

 Article Access Statistics
    Viewed417    
    Printed26    
    Emailed0    
    PDF Downloaded116    
    Comments [Add]    

Recommend this journal