Room for improvement: The HIV-diabetes care continuum over 15 years in the women's interagency HIV study

Background. Gains in life expectancy through optimal control of HIV infection with antiretroviral therapy (ART) may be threatened if other comorbidities, such as diabetes, are not optimally managed. Methods. We analyzed cross-sectional data of the Women's Interagency HIV Study (WIHS) from 2001, 2006, and 2015. We estimated the proportions of HIV-positive and HIV-negative women with diabetes who were engaged in care and achieved treatment goals (hemoglobin A1c [A1c] <7.0%, blood pressure [BP] <140/90 mmHg, low-density lipoprotein [LDL] cholesterol <100 mg/dL, not smoking) and viral suppression. Repeated-measures models were used to estimate the adjusted prevalence of achieving each diabetes treatment goal at each time point, by HIV status. Results. We included 486 HIV-positive and 258 HIV-negative women with diabetes. In 2001, 91.8% visited a health care provider, 60.7% achieved the A1c target, 70.5% achieved the BP target, 38.5% achieved the LDL cholesterol target, 49.2% were nonsmokers, 23.3% achieved combined ABC targets (A1c, BP, and cholesterol), and 10.9% met combined ABC targets and did not smoke. There were no differences by HIV status, and patterns were similar in 2006 and 2015. Among HIV-positive women, viral suppression increased from 41% in 2001 to 87% in 2015 compared with 8% and 13% achieving the ABC goals and not smoking. Viral suppression was not associated with achievement of diabetes care goals. Conclusions. Successful management of HIV is outpacing that of diabetes. Future studies are needed to identify factors associated with gaps in the HIV-diabetes care continuum and design interventions to better integrate effective diabetes management into HIV care

Predicting diabetes risk among HIV-positive and HIV-negative women

Objective:To assess the performance of an adapted American Diabetes Association (ADA) risk score and the concise Finnish Diabetes Risk Score (FINRISC) for predicting type 2 diabetes development in women with and at risk of HIV infection.Design:Longitudinal analysis of the Women's Interagency HIV Study.Methods:The women's Interagency HIV Study is an ongoing prospective cohort study of women with and at risk for HIV infection. Women without prevalent diabetes and 3-year data on fasting blood glucose, hemoglobin A1c, self-reported diabetes medication use, and self-reported diabetes were included. ADA and FINRISC scores were computed at baseline and their ability to predict diabetes development within 3 years was assessed [sensitivity, specificity and area under the receiver operating characteristics (AUROC) curve].Results:A total of 1111 HIV-positive (median age 41, 60% African American) and 454 HIV-negative women (median age 38, 63% African-American) were included. ADA sensitivity did not differ between HIV-positive (77%) and HIV-negative women (81%), while specificity was better in HIV-negative women (42 vs. 49%, P = 0.006). Overall ADA discrimination was suboptimal in both HIV-positive [AUROC = 0.64 (95% CI: 0.58, 0.70)] and HIV-negative women [AUROC = 0.67 (95% CI: 0.57, 0.77)]. FINRISC sensitivity and specificity did not differ between HIV-positive (72 and 49%, respectively) and HIV-negative women (86 and 52%, respectively). Overall FINRISC discrimination was suboptimal in HIV-positive [AUROC = 0.68 (95% CI: 0.62, 0.75)] and HIV-negative women [AUROC = 0.78 (95% CI: 0.66, 0.90)].Conclusion:Model performance was suboptimal in women with and at risk of HIV, while greater misclassification was generally observed among HIV-positive women. HIV-specific risk factors known to contribute to diabetes risk should be explored in these models

Associations between physical activity, cardiorespiratory fitness, and obesity in Mexican children

Objective: To examine the independent relation of physical activity (PA) and cardiorespiratory fitness (fitness) with measures of obesity in Mexican children. Materials and methods. Children (N= 193) in 5th and 6 th grade from Guadalajara participated. Body mass index (BMI), sum of skinfolds (SS) and waist circumference (WC) were measured. PA was measured over four days using pedometry and fitness was measured using the 20 meter shuttle-run test. Results. Fitness and PA were negatively related to the obesity measures in boys and girls (r=-0.57 to -0.64 and r=-0.18 to -0.23 respectively). Age adjusted significant differences in WC, BMI, and SS were observed between the lowest and highest fitness tertiles for boys and girls (p&lt;.0l). Age, gender, and PA adjusted fitness explained 23 to 34% of the variance on WC (r2=0.23, p&lt;01): BMI (r2=0.23, p&lt;.0l), and SS (r2=0.34, p&lt;.0l). Conclusion. Fitness is a stronger correlate and better predictor of obesity than PA in this sample

Associations between physical activity, cardiorespiratory fitness, and obesity in Mexican children

Objective: To examine the independent relation of physical activity (PA) and cardiorespiratory fitness (fitness) with measures of obesity in Mexican children. Materials and methods. Children (N= 193) in 5th and 6 th grade from Guadalajara participated. Body mass index (BMI), sum of skinfolds (SS) and waist circumference (WC) were measured. PA was measured over four days using pedometry and fitness was measured using the 20 meter shuttle-run test. Results. Fitness and PA were negatively related to the obesity measures in boys and girls (r=-0.57 to -0.64 and r=-0.18 to -0.23 respectively). Age adjusted significant differences in WC, BMI, and SS were observed between the lowest and highest fitness tertiles for boys and girls (p&lt;.0l). Age, gender, and PA adjusted fitness explained 23 to 34% of the variance on WC (r2=0.23, p&lt;01): BMI (r2=0.23, p&lt;.0l), and SS (r2=0.34, p&lt;.0l). Conclusion. Fitness is a stronger correlate and better predictor of obesity than PA in this sample