The prevalence of type II diabetes in patients with HIV is an uncommon though important concern. The development of type II diabetes in patients on HAART is 2 to 10%, and its prevalence is directly proportional to the time on therapy. As more patients continue to live longer with HIV while on anti-retroviral therapies, more information will become available as to any direct effect these drugs have on the development of diabetes.
Diabetes in HIV patients is of particular concern because of the nature of HIV and the symptoms that can accompany diabetes. Type II diabetes is the form of diabetes that develops in adults as a result of a gradual decline in insulin sensitivity and a decline in insulin production. More serious problems can emerge in cases of severe type II diabetes, such as:
- Lesions in the retina of the eye
- Diabetic nephropathy
- Diabetic neuropathy
- Bacterial or fungal skin infections
- Cardiovascular disease
As a co-morbidity to HIV, it is understandable why preventing or treating diabetes would be paramount to the overall health of the patient.
Additionally, diabetes substantially increases the risk of heart disease, in part because when large amounts of glucose are present in the blood, it attaches to low-density lipoprotein (LDL). This causes the cholesterol to oxidize more easily, and forms a plaque onto blood vessels. When sucrose attaches to high density lipoprotein (HDL), it is less easy for this cholesterol to be removed from the bloodstream by the liver. High glucose levels also increase blood clotting and reduce the elasticity of blood vessels, both contributing factors in the development of cardiovascular problems.
Patients can prevent or treat diabetes with simple lifestyle changes like diet and exercise, or if it progresses, with medication. Dietary changes recommended for people with diabetes include:
- Increasing fiber intake
- Reducing consumption of saturated fats
- Reducing consumption of trans fatty acids
- Increasing consumption of polyunsaturated fats
Exercise is an important part of cardiovascular health, and can play a pivotal role in the prevention or treatment of diabetes. It is highly recommended that patients exercise vigorously so that the heart rate is above normal for at least 20 minutes daily. Common exercises to achieve this can include:
- Brisk walking
- Jogging
- Swimming
- Cycling
- Aerobics class
Consultation with a specialist HIV dietitian is recommended before commencing a diet targeting diabetes, to ensure it will not worsen wasting levels of blood fats, or the absorption of anti-HIV medications.
Please consult Full Prescribing Information, including boxed WARNING, Medication Guide, and Important Safety Information for VIRAMUNE.
