Patients receiving life-saving, anti-retroviral treatment for HIV are living longer and healthier lives. But there is a downside: As they age, individuals living with HIV are at greater risk of developing heart disease and other chronic health conditions due to HIV-associated inflammation as well as the medications that control the virus. 
 
This can pose special problems for patients who live in lower- and middle-income Latin American countries, such as Mexico and the Dominican Republic, where resources for primary care are limited, according to a new study in the August edition of the journal PLOS ONE. 
 
The international research team includes  Barbara Taylor, M.D., M.S., an associate professor in the School of Medicine at The University of Texas Health Science Center at San Antonio. She has had a long-term interest in infectious diseases from her time as a Fulbright Scholar in Mexico more than 20 years ago.
 
“We already know that many Hispanics are more at risk than non-Hispanics for cardiovascular and metabolic diseases such as obesity and diabetes. In many lower- and middle-income countries, there also is the issue of access to primary care. HIV is often treated in HIV clinics with government-provided HIV medications, but those clinics often don’t offer primary care, leaving these other chronic diseases untreated. 
 
“Unfortunately, this sometimes happens even in underserved areas of the U.S., such as South Texas.  Even though we are in a high-income country, access to care can be an issue in rural or low-income areas where there aren’t many health care providers. We can get HIV medications for our patients through federal assistance programs, but it’s harder to get insulin or other medications to help patients control their diabetes,” Dr. Taylor said.
 
The infectious disease specialist said the research team studied the prevalence and incidence of diabetes, obesity and dyslipidemia (high level of lipids, such as cholesterol, in the blood) in a group of Hispanics diagnosed with HIV just beginning treatment in the Dominican Republic. 
 
The study was conducted from 2007 through 2013 with patients followed for nearly three years. 
 
Analyses were conducted for three groups of conditions: diabetes and impaired fasting glucose; overweight and obesity; and cardiometabolic risk.    
 
The researchers found similar or higher incidences of impaired fasting glucose, diabetes and overweight/obesity than is found in high-income countries. In this study, 28 people developed diabetes for every 1,000 person years of follow up (PYFU), a calculation scientists use to describe the chance of developing a particular condition. The risk of developing diabetes was three to six times higher than data from other low- to middle-income countries such as Africa (10 per 1,000 PYFU) and Thailand (5 per 1,000 PYFU).  
 
The prevalence of overweight/obesity was twice that found in most other countries. Researchers also found that cardiometabolic disorders affected three-quarters of study participants after starting HIV therapy. “This is particularly concerning as the HIV treatment centers are not set up to provide primary or diabetes care,” Dr. Taylor said. 
 
“Twenty years ago, a diagnosis of HIV was a death sentence,” she said. “In order to successfully continue combating the HIV epidemic, we have to start responding to the long-term consequences of chronic HIV infection, such as heart disease prevention, healthy lifestyle promotion and ensuring that we’re not just treating the virus, that we’re providing care for the entire person.” 
 
Other researchers involved in the study are L. Sergio Garduno, a former UT Health Science Center at San Antonio graduate student now pursuing his Ph.D. at Florida State University; Angelina Gomes, Catherine Vaughan, Scott Hammer and Karen Brudney from Columbia University Medical Center, New York, N.Y.; Emily Reyes, Rita Rojas, Lina Jose, Carmen Javier and Yeycy Donastorg from the Instituto Dermatológico y Cirugía de Piel “Dr. Humberto Bogaert Diaz,” Santo Domingo, Dominican Republic; and Geraldine Mir Mesejo and Eliza Del Rosario from the Departamento de Medicina, Profamilia, Santo Domingo, Dominican Republic. http://dx.doi.org/10.1371/journal.pone.0160797
 
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