Detectable viral load in patients taking HIV therapy associated with poor control of other chronic health problems

Poor control of HIV is associated with suboptimal management of other serious health conditions, US research published in the online edition of the Journal of Acquired Immune Deficiency Syndromes suggests.

The study involved patients receiving HIV care at Johns Hopkins University, Baltimore. All were receiving antiretroviral therapy and also had diabetes and/or hypertension (high blood pressure). A detectable viral load was associated with poorer control of the co-morbid conditions.

“This is the first study to demonstrate that poor control of HIV-1 RNA is directly correlated with poor control of diabetes and hypertension, two comorbidities of increasing importance in the management of patients with HIV infection,” comment the investigators.

“We suspect that adherence accounts for our findings, and that poor adherence to antiretroviral therapy correlates with poor adherence to therapy for other medical comorbidities, explaining the relationship between poor control of both conditions.”

Improvements in treatment and care mean that many HIV-positive people now have a realistic chance of a normal life expectancy. However, cardiovascular disease is an increasingly important cause of illness and death in patients with HIV, and the risk can be increased by diabetes or high blood pressure.

Traditional risk factors, the inflammatory effects of untreated HIV, and the side-effects of some antiretroviral drugs may all be causing these co-morbid conditions.

HIV therapy demands high levels of treatment adherence, as does control of diabetes and hypertension. Therefore researchers examined the relationship between HIV control, indicated by an undetectable viral load, and control of diabetes and hypertension. They hypothesised “that poor virologic control would be associated with poor control of diabetes and hypertension.”

A total of 70 patients with diabetes and 291 individuals with hypertension were included in the study.

Diabetes control was assessed by analysing HbA1c measurements (the most common diabetes test, which indicates blood glucose levels). Blood pressure was measured as part of routine clinical care, and systolic and diastolic blood pressure were converted to a measure of mean arterial pressure (MAP).

The patients had a mean age of 46 years, most were black males, and they had a high prevalence of injecting drug use, co-infection with hepatitis C virus, and mental health problems.

Mean baseline body mass index was approximately 26 kg/m², suggesting the patients were slightly overweight.

At the start of the study, the diabetic patients had a median HbA1c of 7.3%, and their median viral load was 126 copies/ml. Baseline MAP for the hypertensive patients was 99.3 mmHg, and their median viral load was 50 copies/ml.

However, each 1 log₁₀ increase in viral load was associated with poorer diabetes control, indicated by a significant increase in levels of HbA1c (p < 0.001). This finding was not affected when the investigators controlled for sex, race, age, type of HIV therapy, CD4 cell count, substance abuse, hepatitis C co-infection, mental health disorders, and the use of insulin.

Similarly, each 1 log₁₀ increase in viral load was associated with a significance increase in MAP (p < 0.001), a finding which was unaffected after adjustment for potential confounders.

“Our findings demonstrate that poor HIV control is related to poor control of diabetes and hypertension, and we suspect that poor adherence to therapy for HIV is correlated with poor adherence to other conditions,” write the authors.

“Research on how patients prioritize medications for their comorbidities in relation to their HIV medications could shape treatment adherence programs,” the investigators conclude.

“The most successful adherence programs combine several interventions…our results argue that the scope of these programs should be expanded to include both antiretroviral agents and agents for other comorbidities.”

Monroe AK et al. Control of medical comorbidities in individuals with HIV. J Acquir Immune Defic Syndr, online edition, doi:10.1097/QAI.0b013e31823801c4, 2011 (click here for the free abstract).