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‘Prolonged ART use can trigger diabetes among HIV/AIDS patients’

Puducherry: FOR a country like ours which is bogged down by the high prevalence of HIV/AIDS and diabetes, this cannot be good news.

Doctors have now found that HIV patients are at the risk of becoming diabetics with prolonged exposure to antiretroviral treatment (ART), and there are no clear guidelines as to how to manage diabetes among 24 lakh HIV patients (UNAIDS, 2009) in the country.

There is a greater need in high prevalence states like Karnataka, Tamil Nadu and Andhra Pradesh, to create awareness among endocrinologists and doctors in ART centres about the diabetes risk in HIV patients, said Dr Sanjay Kalra, endocrinologist, Bharti Hospital, Karnal, Haryana. Dr Kalra, along with a group of doctors from India and Sri Lanka, is in the process of formulating the HIV and diabetes guidelines for South Asia, which will be ready by early 2011.

Talking on the sidelines of the 4th National Insulin Summit held at Puducherry recently, Dr Kalra pointed out that the rate of HIV patients developing diabetes was higher in India as the prevalence of diabetes was higher in the background population. Apart from this, HIV/AIDS patients presented with metabolic disorders, which is an adverse effect of ART medicines. With nearly 50 per cent of diabetes cases going undetected in the country, the numbers would roughly be the same even among HIV patients coming for ART.

“During ART, the medicines play the role of restoring the immune system. However, the sudden surge in immunity can nearly lead to diabetes,” said Dr Kalra, who has had about 8-10 HIV patients coming with complications due to diabetes.

Three categories
HIV patients could be segregated in three categories –– diabetic patients with HIV; patients diagnosed with HIV and diabetes simultaneously; and those who develop diabetes after HIV contraction.

Among these patients too, those at high risk are men, those with HIV for a long time, low CD4 count, high viral load and obesity. Complications that could arise if diabetes among such patients is not managed include diarrhoea, hepatitis and neuropathy.

Management guidelines
While the National AIDS Control Organisation (NACO) had excellent guidelines in management of HIV/AIDS, it did not clearly prescribe how to go about treating diabetes among these patients. It also does not clearly mention what drugs to prescribe for HIV/AIDS patients with diabetes.

“NACO guidelines were made to tackle acute effects of HIV. Now, HIV has become a chronic disease and there is a need to tackle it accordingly,” Dr Kalra said. He added that the present guidelines did not ask doctors to check the history of diabetic HIV patients, no blood glucose tests, etc. In addition to this, the course of treatment was prescribed only for patients on second line of ART with the NACO recognising the risk of diabetes among these patients. However, with studies indicating that diabetes can be contracted in first line too, there is now a need to revise the guidelines.

(Published in Deccan Herald on 8th December, 2010)

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