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Peer N, Nguyen KA, Hill J, Sumner AE, Cikomola JC, Nachega JB, Kengne AP. Prevalence and influences of diabetes and prediabetes among adults living with HIV in Africa: a systematic review and meta-analysis. J Int AIDS Soc 2023; 26:e26059. [PMID: 36924213 PMCID: PMC10018386 DOI: 10.1002/jia2.26059] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 01/11/2023] [Indexed: 03/18/2023] Open
Abstract
INTRODUCTION In people living with human immunodeficiency virus (PLHIV), traditional cardiovascular risk factors, exposure to HIV per se and antiretroviral therapy (ART) are assumed to contribute to cardiometabolic diseases. Nevertheless, controversy exists on the relationship of HIV and ART with diabetes. To clarify the relationship between HIV and type 2 diabetes, this review determined, in PLHIV in Africa, diabetes and prediabetes prevalence, and the extent to which their relationship was modified by socio-demographic characteristics, body mass index (BMI), diagnostic definitions used for diabetes and prediabetes, and HIV-related characteristics, including CD4 count, and use and duration of ART. METHODS For this systematic review and meta-analysis (PROSPERO registration CRD42021231547), a comprehensive search of major databases (PubMed-MEDLINE, Scopus, Web of Science, Google Scholar and WHO Global Health Library) was conducted. Original research articles published between 2000 and 2021 in English and French were included, irrespective of study design, data collection techniques and diagnostic definitions used. Observational studies comprising at least 30 PLHIV and reporting on diabetes and/or prediabetes prevalence in Africa were included. Study-specific estimates were pooled using random effects models to generate the overall prevalence for each diagnostic definition. Data analyses used R statistical software and "meta" package. RESULTS Of the 2614 records initially screened, 366 full-text articles were assessed for eligibility and 61 were selected. In the systematic review, all studies were cross-sectional by design and clinic-based, except for five population-based studies. Across studies included in the meta-analysis, the proportion of men was 16-84%. Mean/median age was 30-62 years. Among 86,412 and 7976 participants, diabetes and prediabetes prevalence rates were 5.1% (95% CI: 4.3-5.9) and 15.1% (9.7-21.5). Self-reported diabetes (3.5%) was lower than when combined with biochemical assessments (6.2%; 7.2%). DISCUSSION While not statistically significant, diabetes and prediabetes were higher with greater BMI, in older participants, urban residents and more recent publications. Diabetes and prediabetes were not significantly different by HIV-related factors, including CD4 count and ART. CONCLUSIONS Although HIV-related factors did not modify prevalence, the diabetes burden in African PLHIV was considerable with suboptimal detection, and likely influenced by traditional risk factors. Furthermore, high prediabetes prevalence foreshadows substantial increases in future diabetes in African PLHIV.
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Affiliation(s)
- Nasheeta Peer
- Non-communicable Diseases Research Unit, South African Medical Research Council, Durban and Cape Town, South Africa.,Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Kim Anh Nguyen
- Non-communicable Diseases Research Unit, South African Medical Research Council, Durban and Cape Town, South Africa
| | - Jillian Hill
- Non-communicable Diseases Research Unit, South African Medical Research Council, Durban and Cape Town, South Africa
| | - Anne E Sumner
- Section on Ethnicity and Health, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Health, Bethesda, Maryland, USA.,National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA
| | - Justin Cirhuza Cikomola
- Faculty of Medicine, Université Catholique de Bukavu, Bukavu, the Democratic Republic of the Congo
| | - Jean Bisimwa Nachega
- Division of Infectious Diseases, Department of Medicine, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa.,Department of Epidemiology, Infectious Diseases, and Microbiology, and Center for Global Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Andre-Pascal Kengne
- Non-communicable Diseases Research Unit, South African Medical Research Council, Durban and Cape Town, South Africa.,Department of Medicine, University of Cape Town, Cape Town, South Africa
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Kitilya B, Peck R, Changalucha J, Jeremiah K, Kavishe BB, Friis H, Filteau S, Krogh-Madsen R, Brage S, Faurholt-Jepsen D, Olsen MF, PrayGod G. The association of physical activity and cardiorespiratory fitness with β-cell dysfunction, insulin resistance, and diabetes among adults in north-western Tanzania: A cross-sectional study. Front Endocrinol (Lausanne) 2022; 13:885988. [PMID: 35992098 PMCID: PMC9381963 DOI: 10.3389/fendo.2022.885988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/05/2022] [Indexed: 02/02/2023] Open
Abstract
Introduction Research on the associations of physical activity and cardiorespiratory fitness with β-cell dysfunction and insulin resistance among adults in Sub-Saharan Africa (SSA) is limited. We assessed the association of physical activity and cardiorespiratory fitness with β-cell function, insulin resistance and diabetes among people living with HIV (PLWH) ART-naïve and HIV-uninfected Tanzanian adults. Method In a cross-sectional study, we collected data on socio-demography, anthropometry, fat mass and fat free mass and C-reactive protein. Data on glucose and insulin collected during an oral glucose tolerance test were used to assess β-cell dysfunction (defined as insulinogenic index <0.71 (mU/L)/(mmol/L), HOMA-β index <38.3 (mU/L)/(mmol/L), and overall insulin release index <33.3 (mU/L)/(mmol/L)), oral disposition index <0.16 (mU/L)/(mg/dL)(mU/L)-1, insulin resistance (HOMA-IR index >1.9 (mU/L)/(mmol/L) and Matsuda index <7.2 (mU/L)/(mmol/L), prediabetes and diabetes which were the dependent variables. Physical activity energy expenditure (PAEE), sleeping heart rate (SHR), and maximum uptake of oxygen during exercise (VO2 max) were the independent variables and were assessed using a combined heart rate and accelerometer monitor. Logistic regressions were used to assess the associations. Results Of 391 participants, 272 were PLWH and 119 HIV-uninfected. The mean age was 39 ( ± 10.5) years and 60% (n=235) were females. Compared to lower tertile, middle tertile of PAEE was associated with lower odds of abnormal insulinogenic index (OR=0.48, 95%CI: 0.27, 0.82). A 5 kj/kg/day increment of PAEE was associated with lower odds of abnormal HOMA-IR (OR=0.91, 95%CI: 0.84, 0.98), and reduced risk of pre-diabetes (RRR=0.98, 95%CI: 0.96, 0.99) and diabetes (RRR=0.92, 95%CI: 0.88, 0.96). An increment of 5 beats per min of SHR was associated with higher risk of diabetes (RRR=1.06, 95%CI: 1.01, 1.11). An increase of 5 mLO2/kg/min of VO2 max was associated with lower risk of pre-diabetes (RRR=0.91, 95%CI: 0.86, 0.97), but not diabetes. HIV status did not modify any of these associations (interaction, p>0.05). Conclusion Among Tanzanian adults PLWH and HIV-uninfected individuals, low physical activity was associated with β-cell dysfunction, insulin resistance and diabetes. Research is needed to assess if physical activity interventions can improve β-cell function and insulin sensitivity to reduce risk of diabetes and delay progression of diabetes in SSA.
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Affiliation(s)
- Brenda Kitilya
- Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania
| | - Robert Peck
- Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania
- Department of Internal Medicine and Pediatrics, Weill Bugando School of Medicine, Mwanza, Tanzania
- Department of Global Health, Weill Cornell Medicine, New York, NY, United States
| | - John Changalucha
- Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania
| | - Kidola Jeremiah
- Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania
| | - Bazil B. Kavishe
- Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Suzanne Filteau
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rikke Krogh-Madsen
- Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark
| | - Soren Brage
- Medical Research Council (MRC) Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | | | - Mette F. Olsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - George PrayGod
- Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania
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Bam NE, Chitha W, Ntsaba J, Nomatshila SC, Apalata T, Mabunda SA. Lifestyle determinants of diabetes mellitus amongst people living with HIV in the Eastern Cape province, South Africa. Afr J Prim Health Care Fam Med 2022; 14:e1-e7. [PMID: 35695437 PMCID: PMC9210181 DOI: 10.4102/phcfm.v14i1.3256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 02/09/2022] [Accepted: 02/13/2022] [Indexed: 12/05/2022] Open
Abstract
Background Type 2 diabetes mellitus (DM) has serious consequences for those affected. Little is documented on the lifestyle determinants of type 2 DM in people living with human immunodeficiency virus (PLWHIV). Aim This study aimed to assess the lifestyle determinants of type 2 DM amongst PLWHIV who were on antiretroviral treatment (ARV). Setting This study was undertaken in 10 community health clinics and 140 clinics in South Africa’s Eastern Cape province. Methods This case control study was undertaken amongst PLWHIV who were on ARV in OR Tambo district. Results Cases and controls showed statistically significant differences on the duration of time on ARV (p < 0.0001), vigorous work (p = 0.019), participation in moderate sport (p = 0.007) and consuming daily fruit and vegetable servings (p = 0.021). Those reporting to be on ARVs for 6 to 10 years were three times more likely to be diabetic than those who had only been on ARV for a year or less (odds ratio [OR] = 3.0; p = 0.017) and in comparison, to participants who reported having one serving, participants who had four fruit and vegetable servings daily were 3.2 times more likely to be diabetic (OR = 3.2; p = 0.002). Conclusion This study revealed significant nutritional imbalances on fruit and vegetable servings and on participation in moderate sport resulting in poor diabetic control. Routine screening and measurements need to focus on dietary and physical lifestyle determinants of type 2 DM in order to counsel patients on ARV on balanced nutrition and optimise outcomes in the quality care of PLWHIV.
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Affiliation(s)
- Nokwanda E Bam
- Department of Nursing, Faculty of Health Sciences, North-West University, Mahikeng.
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Meng L, Kwon KS, Kim DJ, Lee YH, Kim J, Kshirsagar AV, Bang H. Performance of Diabetes and Kidney Disease Screening Scores in Contemporary United States and Korean Populations. Diabetes Metab J 2022; 46:273-285. [PMID: 34503311 PMCID: PMC8987693 DOI: 10.4093/dmj.2021.0054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 05/28/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Risk assessment tools have been actively studied, and they summarize key predictors with relative weights/importance for a disease. Currently, standardized screening scores for type 2 diabetes mellitus (DM) and chronic kidney disease (CKD)-two key global health problems-are available in United States and Korea. We aimed to compare and evaluate screening scores for DM (or combined with prediabetes) and CKD, and assess the risk in contemporary United States and Korean populations. METHODS Four (2×2) models were evaluated in the United States-National Health and Nutrition Examination Survey (NHANES 2015-2018) and Korea-NHANES (2016-2018)-8,928 and 16,209 adults. Weighted statistics were used to describe population characteristics. We used logistic regression for predictors in the models to assess associations with study outcomes (undiagnosed DM and CKD) and diagnostic measures for temporal and cross-validation. RESULTS Korean adult population (mean age 47.5 years) appeared to be healthier than United States counterpart, in terms of DM and CKD risks and associated factors, with exceptions of undiagnosed DM, prediabetes and prehypertension. Models performed well in own country and external populations regarding predictor-outcome association and discrimination. Risk tests (high vs. low) showed area under the curve >0.75, sensitivity >84%, specificity >45%, positive predictive value >8%, and negative predictive value >99%. Discrimination was better for DM, compared to the combined outcome of DM and prediabetes, and excellent for CKD due to age. CONCLUSION Four easy-to-use screening scores for DM and CKD are well-validated in contemporary United States and Korean populations. Prevention of DM and CKD may serve as first-step in public health, with these self-assessment tools as basic tools to help health education and disparity.
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Affiliation(s)
- Liela Meng
- Graduate Group of Biostatistics, Department of Statistics, University of California, Davis, CA, USA
- Corresponding author: Liela Meng https://orcid.org/0000-0001-7767-5354 Department of Statistics, University of California, One Shields Ave, Med-Sci 1C, Davis, CA 95616, USA E-mail:
| | - Keun-Sang Kwon
- Department of Preventive Medicine, Jeonbuk National University Medical School, Jeonju, Korea
| | - Dae Jung Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
| | - Yong-ho Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jeehyoung Kim
- Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Korea
| | - Abhijit V. Kshirsagar
- University of North Carolina Kidney Center & Division of Nephrology and Hypertension, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Heejung Bang
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, CA, USA
- Clinical and Translational Science Center & Center for Healthcare Policy and Research, Davis School of Medicine, University of California, Sacramento, CA, USA
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Rajagopaul A, Naidoo M. Prevalence of diabetes mellitus and hypertension amongst the HIV-positive population at a district hospital in eThekwini, South Africa. Afr J Prim Health Care Fam Med 2021; 13:e1-e6. [PMID: 34636608 PMCID: PMC8517750 DOI: 10.4102/phcfm.v13i1.2766] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 06/21/2021] [Accepted: 06/24/2021] [Indexed: 11/18/2022] Open
Abstract
Background Life expectancies of HIV-positive patients have been increasing with the rapid implementation of antiretroviral therapy (ART). This has led to an increase in comorbidities such as diabetes mellitus (DM) and hypertension (HT) amongst the HIV population. The burden of the non-communicable diseases (NCDs) such as DM and HT need to be quantified in order to ensure that patients receive optimal integrated care as patients often access care at different clinics compromising holistic care. Aim The aim of the study was to determine the prevalence of DM and HT amongst the HIV-positive population. Setting The study was conducted at Wentworth Hospital, a district facility in South Durban, KwaZulu-Natal. Methods This cross-sectional study was undertaken to determine the prevalence of two NCDs, namely DM and HT in HIV-positive patients attending the ART clinic at a district hospital in the eThekwini district. We compared the socio-demographic and clinical profiles of those with and without comorbidities. A sample of 301 HIV-positive patients were administered a structured questionnaire. Results Of the 301 patients, 230 (76.41%) had HIV only (95% confidence interval [CI]: 71.25–80.89) and 71 (23.59%) had HIV and at least one comorbidity, namely DM and/or HT (95% CI: 19.11-28.75). Hypertension was the most prevalent comorbidity. This study revealed that there was no association between the duration of ART and comorbidities. Older age and body mass index (BMI) were associated with comorbidities, whilst gender and ethnicity were not associated. Conclusion Non-communicable diseases such as DM and HT do pose a burden for HIV-positive patients attending the ARV clinic at this district facility. This study highlights the definite need to plan for the increased burden of NCDs as HIV-positive patients live longer and gain weight.
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Affiliation(s)
- Althea Rajagopaul
- Discipline of Family Medicine, Faculty of Health Sciences, University of KwaZulu-Natal, Durban.
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Xu Y, Chen X, Wijayabahu A, Zhou Z, Yu B, Spencer EC, Cook RL. Cumulative HIV Viremia Copy-Years and Hypertension in People Living with HIV. Curr HIV Res 2021; 18:143-153. [PMID: 32003696 DOI: 10.2174/1570162x18666200131122206] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/14/2020] [Accepted: 01/21/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Evidence regarding the association between HIV viral load (VL) and hypertension is inconsistent. In this study, we investigated the relationship using viremia copy-years (VCY), a cumulative measure of HIV plasma viral burden. METHODS Data were analyzed for 686 PLWH in the Florida Cohort Study, who had at least five years of VL data before the baseline. VL data were extracted from Enhanced HIV/AIDS Reporting System (eHARS) and used to define peak VL (pVL), recent VL (rVL), and undetectable VL (uVL: rVL<50copies/mL). A five-year VCY (log10 copy × years/mL) before the baseline investigation, was calculated and divided into 5 groups (≤2.7, 2.8-3.7, 3.8-4.7, 4.8-5.7 and >5.7) for analysis. Hypertension was determined based on hypertension diagnosis from medical records. Multivariable logistic regression was used for association analysis. RESULTS Of the total sample, 277 (40.4%) participants were hypertensive. Compared to the participants with lowest VCY (≤2.7 log10 copy × years/mL), the odds ratios (OR) and 95% confidence interval [95% CI] for hypertension of the remaining four groups, in order, were 1.91 [1.11, 3.29], 1.91 [1.03, 3.53], 2.27 [1.29, 3.99], and 1.25 [0.65, 2.42], respectively, controlling for confounders. The association was independent of pVL, rVL, and uVL, each of which was not significantly associated with hypertension. CONCLUSION Persistent HIV infection is a risk factor for hypertension among PLWH. Information provided by VCY is more effective than single time-point VL measures in investigating HIV infection- hypertension relationship. The findings of this study support the significance of continuous viral suppression in hypertension prevention among PLWH.
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Affiliation(s)
- Yunan Xu
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, Florida, United States.,Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, United States
| | - Xinguang Chen
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, Florida, United States
| | - Akemi Wijayabahu
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, Florida, United States
| | - Zhi Zhou
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, Florida, United States
| | - Bin Yu
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, Florida, United States
| | - Emma C Spencer
- Florida Department of Health, Division of Disease Control and Health Protection, Bureau of Communicable Diseases, HIV/AIDS Section, Tallahassee, Florida, United States
| | - Robert L Cook
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, Florida, United States
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Egede LE, Walker RJ, Monroe P, Williams JS, Campbell JA, Dawson AZ. HIV and cardiovascular disease in sub-Saharan Africa: Demographic and Health Survey data for 4 countries. BMC Public Health 2021; 21:1122. [PMID: 34118912 PMCID: PMC8196536 DOI: 10.1186/s12889-021-11218-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 06/01/2021] [Indexed: 11/18/2022] Open
Abstract
Background Investigate the relationship between two common cardiovascular diseases and HIV in adults living in sub-Saharan Africa using population data provided through the Demographic and Health Survey. Methods Data for four sub-Saharan countries were used. All adults asked questions regarding diagnosis of HIV, diabetes, and hypertension were included in the sample totaling 5356 in Lesotho, 3294 in Namibia, 9917 in Senegal, and 1051 in South Africa. Logistic models were run for each country separately, with self-reported diabetes as the first outcome and self-reported hypertension as the second outcome and HIV status as the primary independent variable. Models were adjusted for age, gender, rural/urban residence and BMI. Complex survey design allowed weighting to the population. Results Prevalence of self-reported diabetes ranged from 3.8% in Namibia to 0.5% in Senegal. Prevalence of self-reported hypertension ranged from 22.9% in Namibia to 0.6% in Senegal. In unadjusted models, individuals with HIV in Lesotho were 2 times more likely to have self-reported diabetes (OR = 2.01, 95% CI 1.08–3.73), however the relationship lost significance after adjustment. Individuals with HIV were less likely to have self-reported diabetes after adjustment in Namibia (OR = 0.29, 95% CI 0.12–0.72) and less likely to have self-reported hypertension after adjustment in Lesotho (OR = 0.63, 95% CI 0.47–0.83). Relationships were not significant for Senegal or South Africa. Discussion HIV did not serve as a risk factor for self-reported cardiovascular disease in sub-Saharan Africa during the years included in this study. However, given the growing prevalence of diabetes and hypertension in the region, and the high prevalence of undiagnosed cardiovascular disease, it will be important to continue to track and monitor cardiovascular disease at the population level and in individuals with and without HIV. Conclusions The odds of self-reported diabetes in individuals with HIV was high in Lesotho and low in Namibia, while the odds of self-reported hypertension in individuals with HIV was low across all 4 countries included in this study. Programs are needed to target individuals that need to manage multiple diseases at once and should consider increasing access to cardiovascular disease management programs for older adults, individuals with high BMI, women, and those living in urban settings.
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Affiliation(s)
- Leonard E Egede
- Department of Medicine, Division of General Internal Medicine, Froedtert & The Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226-3596, USA. .,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Rebekah J Walker
- Department of Medicine, Division of General Internal Medicine, Froedtert & The Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226-3596, USA.,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Patricia Monroe
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Joni S Williams
- Department of Medicine, Division of General Internal Medicine, Froedtert & The Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226-3596, USA.,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jennifer A Campbell
- Department of Medicine, Division of General Internal Medicine, Froedtert & The Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226-3596, USA.,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Aprill Z Dawson
- Department of Medicine, Division of General Internal Medicine, Froedtert & The Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226-3596, USA.,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
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Umar DM, Naidoo P. Prevalence and predictors of diabetes mellitus among persons living with HIV: a retrospective cohort study conducted in 4 public healthcare facilities in KwaZulu-Natal. BMC Public Health 2021; 21:288. [PMID: 33541316 PMCID: PMC7863241 DOI: 10.1186/s12889-021-10318-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 01/24/2021] [Indexed: 11/28/2022] Open
Abstract
Background Diabetes mellitus is a chronic non-infectious medical condition which is evident by raised levels of glucose in the blood, because the body cannot produce any or enough of the hormone insulin or use insulin effectively. Diabetes, if not well managed leads to complications such as neuropathy, retinopathy, nephropathy which can be fatal. Some of the factors that predisposes to diabetes include older age, higher body mass index, heredity and hypertension. With the availability of HAART for managing HIV/AIDS infection, life span of persons living with HIV (PLWHIV) has increased significantly. With increased longevity, the aging population of PLWHIV also face chronic diseases such as diabetes in addition to HIV. The burden of both HIV and diabetes is high in South Africa, particularly in KwaZulu-Natal. Nevertheless, the prevalence of diabetes among PLWHIV in KwaZulu-Natal and its predictors is not well understood. Therefore, this study was conducted to determine the prevalence, predictors of diabetes and the outcome of managing diabetes among PLWHIV. Methods This retrospective cohort study was conducted in four public health care facilities in KwaZulu-Natal with a total sample size of 1203 after ethical approval and informed consent were obtained. A pretested questionnaire and hospital patient charts were used to collect data. SPSS version 26 was used to analyze the data using descriptive statistics and logistic regression. Results The prevalence of diabetes among PLWHIV was 9%. Just over 47% of those who had diabetes, had uncontrolled blood sugar, with a mean fasting blood sugar (FBS) of 11.7 mmol/L. The predictors of diabetes among PLWHIV were male gender and older age. Male PLWHIV had 65% less chances of having diabetes and those who were between the ages of 18 and 48 years were 88% less probable to have diabetes compared to those who were older than 48 years. Conclusion Public sector health care facilities in KwaZulu-Natal need to do much more to manage diabetes in PLWHIV in order to prevent diabetic complications and possible negative impact on the outcome of HIV management. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10318-6.
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Affiliation(s)
- David Mohammed Umar
- Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu-Natal, Westville, Durban, South Africa.
| | - Panjasaram Naidoo
- Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu-Natal, Westville, Durban, South Africa
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Bam NE, Mabunda SA, Ntsaba J, Apalata T, Nomatshila SC, Chitha W. The association between HIV tri-therapy with the development of Type-2 Diabetes Mellitus in a rural South African District: A case-control study. PLoS One 2020; 15:e0244067. [PMID: 33382732 PMCID: PMC7775046 DOI: 10.1371/journal.pone.0244067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 12/02/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Combination antiretroviral drugs (cARVs) prolong patients' lives but are unfortunately thought to increase complications related to metabolic disorders including type-2 Diabetes Mellitus (DM). We sought to confirm the association of cARVs with type-2 DM and ascertain the extent of this association in a rural South African setting. METHODS A case-control study of 177 (33.33%) cases with HIV/AIDS and type-2 DM were selected and compared with 354 (66.67%) non-DM HIV/AIDS unmatched controls from a rural district of South Africa's third most populous province (Eastern Cape). Cases were identified from community health centres using the district health information system, and controls were identified using simple random sampling from the same health facilities. Odds Ratios (OR), together with 95% confidence intervals, were calculated for all the univariable and multivariable logistic analyses. RESULTS This study found that cARVs significantly increased the occurrence of type-2 DM among HIV patients. Patients on protease inhibitors (PIs) were at least 21 times significantly (p<0.0001) more likely to be diabetic than those on the fixed dose combination (FDC); those on stavudine (D4T) and zidovudine (AZT) were 2.45 times and 9.44 times respectively more likely to be diabetic than those on FDC (p<0.05). The odds of diabetes increased by more than three-folds for those who had been on antiretroviral drugs for more than 6 years (p<0.005). CONCLUSION This study has been able to establish the association between cARVs and type-2 DM. It therefore proposes consideration of the usage of AZT, D4T, lopivavir and ritonavir for the treatment of HIV. The study further proposes more prospective research to test these findings further.
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Affiliation(s)
- Nokwanda E Bam
- Department of Nursing, Walter Sisulu University, Mthatha, South Africa
| | - Sikhumbuzo A Mabunda
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Jafta Ntsaba
- Department of Nursing, Walter Sisulu University, Mthatha, South Africa
| | - Teke Apalata
- Department of Laboratory Medicine, Walter Sisulu University, Mthatha, South Africa
| | | | - Wezile Chitha
- Health Systems Enablement & Innovation Unit, University of the Witwatersrand, Johannesburg, South Africa
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10
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da Cunha GH, Franco KB, Galvão MTG, Lima MAC, Fontenele MSM, Siqueira LR, Ramalho AKL, Fechine FV. Diabetes mellitus in people living with HIV/AIDS: prevalence and associated risk factors. AIDS Care 2019; 32:600-607. [PMID: 31760760 DOI: 10.1080/09540121.2019.1695727] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The objectives of this study were to estimate the prevalence of diabetes mellitus in people with HIV/AIDS and to assess the associated risk factors. A cross-sectional study with 168 patients treated at an infectious disease outpatient. Were investigated sociodemographic, epidemiological and clinical variables through interview using forms. Casual plasma glucose, blood pressure and anthropometric data were recorded. For the analysis, we used descriptive statistics and logistic regression. The results showed that most patients were male, single, with 9-12 years of schooling, in the category of sexual exposure and heterosexual. The prevalence of diabetes mellitus was 7.14%, and risk factors were smoking, alcohol use, inadequate diet, increased abdominal circumference, overweight, age over 45 years, family history of diabetes and personal history of hypertension. Women were 5.29 times more likely to have increased abdominal circumference (P < 0.001). Men (P = 0.003), married (P = 0.035), with monthly income greater than two times the minimum wage (P = 0.035) were more likely to be hypertensive. Diabetes occurred in older patients (P = 0.008). In conclusion, the prevalence of people with HIV/AIDS and diabetes mellitus was 7.14%, and most had modifiable risk factors for diabetes, including smoking, alcohol use, inadequate diet and overweight, needing health education interventions for diabetes prevention.
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11
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Masenga SK, Toloka P, Chiyenu K, Imasiku I, Mutengo H, Ulungu ON, Mallesu Z, Mulenga E, Mutukwa M, Kamvuma K, Hamooya BM. Type 2 diabetes mellitus prevalence and risk scores in treated PLWHIV: a cross-sectional preliminary study. BMC Res Notes 2019; 12:145. [PMID: 30876484 PMCID: PMC6420761 DOI: 10.1186/s13104-019-4183-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/11/2019] [Indexed: 12/22/2022] Open
Abstract
Objective This was a preliminary study whose objective was to estimate the prevalence and risk of developing type 2 diabetes mellitus (T2DM) among people living with HIV (PLWHIV) based on diabetes risk assessment scores. Results The study was composed of 234 PLWHIV with median age (interquartile range, IQR) of 44 (36, 52) and a female preponderance of 66%. The median risk scores (IQR) for developing T2DM was 5 (2, 9). Based on the risk scores, 5% of PLWHIV were at high risk for developing T2DM close to 3.4% actual prevalence in the study population. This study demonstrated the importance of using a cheap and fast method for identifying high risk individuals for developing T2DM. Electronic supplementary material The online version of this article (10.1186/s13104-019-4183-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sepiso K Masenga
- School of Medicine and Health Sciences, Mulungushi University, Livingstone Campus, Livingstone, Zambia. .,Research Section, Pathology Laboratory Department, Livingstone Central Hospital, Akapelwa Street, Livingstone, Zambia. .,Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka, Zambia.
| | - Paul Toloka
- Research Section, Pathology Laboratory Department, Livingstone Central Hospital, Akapelwa Street, Livingstone, Zambia
| | - Kaseya Chiyenu
- Internal Medicine, Livingstone Central Hospital, Akapelwa Street, Livingstone, Zambia
| | - Ilubala Imasiku
- Chikankata College of Biomedical Sciences, Private Bag Sector 2, Mazabuka, Zambia
| | - Hope Mutengo
- Internal Medicine, Livingstone Central Hospital, Akapelwa Street, Livingstone, Zambia
| | - Oscar Ngongo Ulungu
- Internal Medicine, Livingstone Central Hospital, Akapelwa Street, Livingstone, Zambia
| | - Zangi Mallesu
- Research Section, Pathology Laboratory Department, Livingstone Central Hospital, Akapelwa Street, Livingstone, Zambia
| | - Eunice Mulenga
- Research Section, Pathology Laboratory Department, Livingstone Central Hospital, Akapelwa Street, Livingstone, Zambia
| | - Macwañi Mutukwa
- Research Section, Pathology Laboratory Department, Livingstone Central Hospital, Akapelwa Street, Livingstone, Zambia
| | - Kingsley Kamvuma
- School of Medicine and Health Sciences, Mulungushi University, Livingstone Campus, Livingstone, Zambia
| | - Benson M Hamooya
- School of Medicine and Health Sciences, Mulungushi University, Livingstone Campus, Livingstone, Zambia.,Research Section, Pathology Laboratory Department, Livingstone Central Hospital, Akapelwa Street, Livingstone, Zambia.,School of Public Health, University of Zambia, Lusaka, Zambia
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12
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Mudumbi JBN, Ntwampe SKO, Mekuto L, Matsha T, Itoba-Tombo EF. The role of pollutants in type 2 diabetes mellitus (T2DM) and their prospective impact on phytomedicinal treatment strategies. ENVIRONMENTAL MONITORING AND ASSESSMENT 2018; 190:262. [PMID: 29610974 DOI: 10.1007/s10661-018-6634-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 03/22/2018] [Indexed: 06/08/2023]
Abstract
Type 2 diabetes mellitus (T2DM) is the most common form of diabetes and it is characterized by high blood sugar and abnormal sera lipid levels. Although the specific reasons for the development of these abnormalities are still not well understood, traditionally, genetic and lifestyle behavior have been reported as the leading causes of this disease. In the last three decades, the number of diabetic patients has drastically increased worldwide, with current statistics suggesting the number is to double in the next two decades. To combat this incurable ailment, orthodox medicines, to which economically disadvantaged patients have minimal access to, have been used. Thus, a considerable amalgamation of medicinal plants has recently been proven to possess therapeutic capabilities to manage T2DM, and this has prompted studies primarily focusing on the healing aspect of these plants, and ultimately, their commercialization. Hence, this review aims to highlight the potential threat of pollutants, i.e., polyfluoroalkyl compounds (PFCs), endocrine disrupting chemicals (EDCs) and heavy metals, to medicinal plants, and their prospective impact on the phytomedicinal therapy strategies for T2DM. It is further suggested that auxiliary research be undertaken to better comprehend the factors that influence the uptake of these compounds by these plants. This should include a comprehensive risk assessment of phytomedicinal products destined for the treatment of T2DM. Regulations that control the use of PFC-precursors in certain developing countries are also long overdue.
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Affiliation(s)
- John Baptist Nzukizi Mudumbi
- Bioresource Engineering Research Group (BioERG), Department of Biotechnology, Cape Peninsula University of Technology, PO Box 652, Cape Town, 8000, South Africa.
| | - Seteno Karabo Obed Ntwampe
- Bioresource Engineering Research Group (BioERG), Department of Biotechnology, Cape Peninsula University of Technology, PO Box 652, Cape Town, 8000, South Africa
| | - Lukhanyo Mekuto
- Department of Chemical Engineering, University of Johannesburg, PO Box 17011, Johannesburg, Gauteng, 2028, South Africa
| | - Tandi Matsha
- Department of Bio-Medical sciences, Faculty of Health and Wellness Science, Cape Peninsula University of Technology, PO Box 1906, Bellville, 7535, South Africa
| | - Elie Fereche Itoba-Tombo
- Bioresource Engineering Research Group (BioERG), Department of Biotechnology, Cape Peninsula University of Technology, PO Box 652, Cape Town, 8000, South Africa
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13
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Njuguna B, Kiplagat J, Bloomfield GS, Pastakia SD, Vedanthan R, Koethe JR. Prevalence, Risk Factors, and Pathophysiology of Dysglycemia among People Living with HIV in Sub-Saharan Africa. J Diabetes Res 2018; 2018:6916497. [PMID: 30009182 PMCID: PMC5989168 DOI: 10.1155/2018/6916497] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 04/03/2018] [Accepted: 04/15/2018] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To review available literature on the prevalence, risk factors, pathophysiology, and clinical outcomes of dysglycemia among people living with HIV (PLHIV) in sub-Saharan Africa (SSA). METHODS Database search on PUBMED for eligible studies describing the prevalence, risk factors, pathophysiology, or clinical outcomes of dysglycemia in SSA PLHIV. RESULTS Prevalence of diabetes mellitus (DM) and pre-DM among SSA PLHIV ranged from 1% to 26% and 19% to 47%, respectively, in 15 identified studies. Older age and an elevated body mass index (BMI) were common risk factors for dysglycemia. Risk factors potentially more specific to PLHIV in SSA included exposure to older-generation thymidine analogues or protease inhibitors, malnutrition at ART initiation, a failure to gain fat mass on treatment, and elevated serum lipids. There is evidence of higher nephropathy and neuropathy rates among PLHIV in SSA with comorbid DM compared to HIV-negative individuals with DM. CONCLUSION There is a need for longitudinal studies to enhance understanding of the risk factors for dysglycemia among PLHIV in SSA, further research into optimal therapies to reduce pre-DM progression to DM among SSA PLHIV, and studies of the burden and phenotype of diabetic complications and other health outcomes among PLHIV with comorbid DM in SSA.
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Affiliation(s)
- Benson Njuguna
- Moi Teaching and Referral Hospital, P.O. Box 4606-30100, Eldoret, Kenya
| | - Jepchirchir Kiplagat
- Academic Model Providing Access to Healthcare (AMPATH), P.O. Box 4606-30100, Eldoret, Kenya
| | - Gerald S. Bloomfield
- Duke Clinical Research Institute, Duke Global Health Institute, Duke University, 2400 Pratt Street, Durham, NC 27710, USA
| | - Sonak D. Pastakia
- Purdue University College of Pharmacy, P.O. Box 5760 Eldoret 30100, Kenya
| | - Rajesh Vedanthan
- Zena and Michael A. Wiener Cardiovascular Institute, Department of Medicine and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, P.O. Box 1030, New York, NY 10029, USA
| | - John R. Koethe
- Division of Infectious Diseases, Vanderbilt University Medical Center, A2200-MCN 1161 21st Avenue South, Nashville, TN 37232, USA
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14
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Carrasco-Hernandez R, Jácome R, López Vidal Y, Ponce de León S. Are RNA Viruses Candidate Agents for the Next Global Pandemic? A Review. ILAR J 2017; 58:343-358. [PMID: 28985316 PMCID: PMC7108571 DOI: 10.1093/ilar/ilx026] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 07/14/2017] [Accepted: 07/15/2017] [Indexed: 12/16/2022] Open
Abstract
Pathogenic RNA viruses are potentially the most important group involved in zoonotic disease transmission, and they represent a challenge for global disease control. Their biological diversity and rapid adaptive rates have proved to be difficult to overcome and to anticipate by modern medical technology. Also, the anthropogenic change of natural ecosystems and the continuous population growth are driving increased rates of interspecies contacts and the interchange of pathogens that can develop into global pandemics. The combination of molecular, epidemiological, and ecological knowledge of RNA viruses is therefore essential towards the proper control of these emergent pathogens. This review outlines, throughout different levels of complexity, the problems posed by RNA viral diseases, covering some of the molecular mechanisms allowing them to adapt to new host species-and to novel pharmaceutical developments-up to the known ecological processes involved in zoonotic transmission.
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Affiliation(s)
- R Carrasco-Hernandez
- R. Carrasco-Hernandez, PhD, is a postdoctoral research fellow at the Microbiome Laboratory in the Postgraduate Division of the Faculty of Medicine at the Universidad Nacional Autónoma de México, CDMX
| | - Rodrigo Jácome
- Rodrigo Jácome, MD, PhD, is a postdoctoral research fellow at the Microbiome Laboratory in the Postgraduate Division of the Faculty of Medicine at the Universidad Nacional Autónoma de México, CDMX
| | - Yolanda López Vidal
- Yolanda López-Vidal, MD, PhD, is an associate professor “C” and is responsible for the Program of Microbial Molecular Immunology in the Department of Microbiology and Parasitology of the Faculty of Medicine at the Universidad Nacional Autónoma de México, CDMX
| | - Samuel Ponce de León
- Samuel Ponce-de-León, MD, MSc, is an associate professor “C”, is responsible for the Microbiome Laboratory and Coordinator of the University Program for Health Research of the Faculty of Medicine at the Universidad Nacional Autónoma de México, CDMX
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15
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Husain NE, Noor SK, Elmadhoun WM, Almobarak AO, Awadalla H, Woodward CL, Mital D, Ahmed MH. Diabetes, metabolic syndrome and dyslipidemia in people living with HIV in Africa: re-emerging challenges not to be forgotten. HIV AIDS (Auckl) 2017; 9:193-202. [PMID: 29184449 PMCID: PMC5685138 DOI: 10.2147/hiv.s137974] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The current challenge in managing people living with human immunodeficiency virus (PLWHIV) includes the identification and monitoring for comorbid health risks associated with HIV and its treatment and longer survival. Dyslipidemia, diabetes mellitus and metabolic syndrome are increasingly seen in PLWHIV. OBJECTIVE In this narrative review, we aimed to summarize the current knowledge about diabetes, dyslipidemia and metabolic syndrome in PLWHIV in Africa and also to discuss the challenges that patients as well as health authorities in Africa may face. METHODS PubMed and Google scholar published-English literatures concerning earlier mentioned entities regardless of time limit were critically reviewed. RESULTS The prevalence of metabolic disorders in HIV population in Africa was estimated to range from 2.1% to 26.5% for diabetes and 20.2% to 43.5% for pre-diabetes, 13% to 58% for metabolic syndrome and 13% to 70% for dyslipidemia. CONCLUSION The management of metabolic disorders and cardiovascular disease risks related to HIV is complex especially in Africa due to healthcare resources, but our experience suggests that metabolic clinic is beneficial to patients and staff and should be an important part of HIV services especially as the older HIV population is increasing. In this context, cardiovascular risk assessment of HIV-infected patients will become an important component of care in developing countries in Africa and strategies are needed to deal with progressive increase in the epidemic of type 2 diabetes, dyslipidemia and metabolic syndrome.
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Affiliation(s)
- Nazik Elmalaika Husain
- Department of Pathology, Faculty of Medicine and Health Sciences, Omdurman Islamic University, Khartoum
| | | | - Wadie M Elmadhoun
- Department of Pathology, Faculty of Medicine and Health Sciences, Nile Valley University, Atbara
| | - Ahmed O Almobarak
- Department of Pathology, Faculty of Medicine, University of Medical Sciences and Technology
| | - Heitham Awadalla
- Department of Community Medicine, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Clare L Woodward
- Department of HIV and Genitourinary Medicine, Milton Keynes University Hospital, NHS Foundation Trust, Milton Keynes, UK
| | - Dushyant Mital
- Department of HIV and Genitourinary Medicine, Milton Keynes University Hospital, NHS Foundation Trust, Milton Keynes, UK
| | - Mohamed H Ahmed
- Department of Medicine and HIV Metabolic Clinic, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes, UK
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