Why do women with HIV have a higher risk of developing diabetes than men?
Researchers from the University of California analysed a dataset covering nearly 40,000 people living with HIV to establish a relationship between HIV, sex, and type 2 diabetes. The results have been published in the journal, AIDS.
Type 2 diabetes is a condition in which the body, whilst able to produce the hormone insulin, is less able to make use of it due to reduced sensitivity of receptors. Insulin regulates your bloody sugar levels, and problems with insulin levels can lead to increased risk of cardiovascular diseases, slow wound healing and more. The main risk factors for type 2 diabetes are obesity, age and genetic profile.
The authors of the study wanted to establish whether women living with HIV are more likely to get diabetes than men. To do this they analysed the health data of 39,485 people living with HIV (PLHIV) and compared their results to a control group of more than 19 million people.
The analysis confirmed a relationship between HIV and type 2 diabetes in women, even taking into account all other demographics and risk factors.
In the PLHIV group, diabetes had been diagnosed in 23% of women and 16% of men. When compared to the control group 17% of men had been diagnosed with HIV and only 14% of women. This shows that women living with HIV are 1.3 times more prone to diabetes than those without HIV.
Obesity rates were also higher in women living with HIV, 58% compared to 49% in the control group, once again this was the opposite in men - with 35% of men living with HIV being obese, and 46% of those without HIV. Obesity increased the risk of diabetes in both groups.
So, why do women with HIV had a higher risk of developing diabetes?
The researchers think there are several key reasons that could be driving the higher risk of diabetes in women living with HIV.
- Immune response to HIV. Women have a stronger immune response to initial HIV infection due to exposure to sex hormones. Whilst initially useful for controlling the virus, it can lead to greater insulin resistance.
- Obesity. Women living with HIV tend to be more obese than both women living without HIV and men in general. This can, in part, be explained by the “complex paradigm” of gender and socio-economic status. Grossly generalising, men are less likely to be economically deprived and face health inequalities - this means they have better access to quality nutrition, education and medical services.
- HIV treatment. Some research has shown than integrase inhibitors, one of the most common classes of HIV treatment, can increase the risk of diabetes in women more than it does in men.
It should also be noted that women are much less likely to participate in research - this may in part because trials often recruit men over women, or that women have concerns about trials impact on their reproductive health. The study’s authors say that research that can highlight gender inequality should become a standard.
