Diabetes mellitus and risk factors in human immunodeficiency virus-infected individuals at Jimma University Specialized Hospital, Southwest Ethiopia

Diagnosis and Risk Factors of Prediabetes and Diabetes in People Living With Human Immunodeficiency Virus: Evaluation of Clinical and Microbiome Parameters

Diabetes mellitus (DM) is more common among people living with human immunodeficiency virus (PLWH) compared with healthy individuals. In a prospective multicenter study (N = 248), we identified normoglycemic (48.7%), prediabetic (44.4%), and diabetic (6.9%) PLWH. Glycosylated hemoglobin (HbA1c) and fasting blood glucose (FBG) sensitivity in defining dysglycemia was 96.8%, while addition of oral glucose tolerance test led to reclassification of only 4 patients. Inclusion of 93 additional PLWH with known DM enabled identification of multiple independent predictors of dysglycemia or diabetes: older age, higher body mass index, Ethiopian origin, HIV duration, lower integrase inhibitor exposure, and advanced disease at diagnosis. Shotgun metagenomic microbiome analysis revealed 4 species that were significantly expanded with hyperglycemia/hyperinsulinemia, and 2 species that were differentially more prevalent in prediabetic/diabetic PLWH. Collectively, we uncover multiple potential host and microbiome predictors of altered glycemic status in PLWH, while demonstrating that FBG and HbA1c likely suffice for diabetes screening. These potential diabetic predictors merit future prospective validation.

The burden of non-communicable diseases among people living with HIV in Sub-Saharan Africa: a systematic review and meta-analysis

Background

Non-communicable diseases (NCDs) are increasing among people living with HIV (PLHIV), especially in Sub-Saharan Africa (SSA). We determined the prevalence of NCDs and NCD risk factors among PLHIV in SSA to inform health policy makers.

Methods

We conducted a systematic review and meta-analysis on the prevalence of NCDs and risk factors among PLHIV in SSA. We comprehensively searched PubMed/MEDLINE, Scopus, and EBSCOhost (CINAHL) electronic databases for sources published from 2010 to July 2023. We applied the random effects meta-analysis model to pool the results using STATA. The systematic review protocol was registered on PROSPERO (registration number: CRD42021258769).

Findings

We included 188 studies from 21 countries in this meta-analysis. Our findings indicate pooled prevalence estimates for hypertension (20.1% [95% CI:17.5-22.7]), depression (30.4% [25.3-35.4]), diabetes (5.4% [4.4-6.4]), cervical cancer (1.5% [0.1-2.9]), chronic respiratory diseases (7.1% [4.0-10.3]), overweight/obesity (32.2% [29.7-34.7]), hypercholesterolemia (21.3% [16.6-26.0]), metabolic syndrome (23.9% [19.5-28.7]), alcohol consumption (21.3% [17.9-24.6]), and smoking (6.4% [5.2-7.7]).

Interpretation

People living with HIV have a high prevalence of NCDs and their risk factors including hypertension, depression, overweight/obesity, hypercholesterolemia, metabolic syndrome and alcohol consumption. We recommend strengthening of health systems to allow for improved integration of NCDs and HIV services in public health facilities in SSA. NCD risk factors such as obesity, hypercholesterolemia, and alcohol consumption can be addressed through health promotion campaigns. There is a need for further research on the burden of NCDs among PLHIV in most of SSA.

Funding

This study did not receive any funding.

The association of aspartate transaminase-to-alanine transaminase ratio and metabolic syndrome among HIV patients in Sidama Region, South Ethiopia

Objective

Studies on the association of the aspartate transaminase-to-alanine transaminase ratio with the metabolic syndrome and its components among HIV patients were scarce. This study aims to determine the association between the aspartate transaminase-to-alanine transaminase ratio and the metabolic syndrome and its components in adult HIV patients on highly active antiretroviral therapy.

Methods

This was a cross-sectional study conducted on 302 HIV patients from January 15 to June 30, 2021. Sociodemographic, clinical, and anthropometric data were collected using a structured questionnaire. The patient's medical records were reviewed. Biochemical analysis was performed after 5 ml of venous blood was collected from each study participant. Metabolic syndrome was defined by the third report of the national cholesterol education program-adult treatment panel. Logistic regression was done to assess the association of MetS with the independent variables, and correlation analysis was performed to see the correlation of MetS components with the aspartate aminotransferase-to-alanine aminotransferase ratio.

Result

302 HIV-positive patients on highly active antiretroviral therapy were included in this study, and 54.6% were female. The median and interquartile range of the age of the study participants were 41 (35-50) years. The prevalence of metabolic syndrome was 29.5% (confidence interval = 24.5-35.1). Chronic illness (Adjusted odds ratio = 4.8, confidence interval = 2.2-10.9) and aspartate aminotransferase-to-alanine aminotransferase ratio (adjusted odds ratio = 2.5, confidence interval = 1.4-4.4) were significantly associated with Metabolic syndrome among the study participants. The aspartate aminotransferase-to-alanine aminotransferase ratio was significantly correlated with blood pressure.

Conclusion

This study found the existence of a significant association between the aspartate aminotransferase-to-alanine aminotransferase ratio and metabolic syndrome among HIV patients.

Prevalence of hypertension and diabetes and associated risk factors among people living with human immunodeficiency virus in Southern Ethiopia

Background

Access to antiretroviral therapy (ART) allows people living with HIV (PLWH) to live longer. Consequently, non communicable diseases (NCD) have emerged as the main drivers of ill health, disability, and premature death. This study assessed the magnitude of hypertension and diabetes and risk factors among PLWH receiving ART in Ethiopia.

Methods

A cross-sectional study was conducted using an analytical component. Data were collected through face-to-face interviews, physical measurements, and chart reviews of the 520 adults. Associations between the demographic and clinical attributes of hypertension and diabetes were assessed using logistic regression models.

Results

Prevalence of hypertension was (18.5%) (95% CI: 15.2%-21.7%), and diabetes was (6.9%) (95% CI: 4.8%-9.2%). More than two-thirds (70.8%) and 61% were newly diagnosed with hypertension and diabetes, respectively. Age > = 45 years [adjusted odds ratio (AOR) = 2.47], alcohol consumption (AOR = 4.51), Insufficient physical activity (AOR = 3.7), BMI ≥25 (AOR = 3.95), family history of hypertension (AOR = 7.1), and diabetes (AOR = 4.95) were associated with hypertension. Age ≥45 years [adjusted odds ratio (AOR) = 2.47], BMI ≥25 (AOR = 1.91), Central obesity (AOR = 3.27), detectable viral load (AOR = 4.2), hypertension (AOR = 4.95) and duration of ART >10 years (AOR = 3.12) were associated with diabetes.

Conclusions

A combination of modifiable and nonmodifiable factors increased the risk of hypertension and diabetes. Primary prevention strategies, regular screening for hypertension and diabetes and integration with HIV care in primary health care are the recommended intervention measures.

Prevalence and influences of diabetes and prediabetes among adults living with HIV in Africa: a systematic review and meta-analysis

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.

Epidemiologic transition and the double burden of disease in Ghana: What do we know at the neighborhood level?

Many developing countries including Ghana are currently experiencing dual disease burdens emerging from an unprecedented risk overlap that drive their epidemiological transitions. Yet, siloed and disintegrated approaches continue to take precedence in health research and policy programs that drive competition for limited resources to address competing health problems. The objective of this study was to offer empirical evidence in support of a cogent argument for an integrated framework for the study and management of infectious and chronic health conditions in Ghana. We did so by examining the prevalence, determinants, and neighborhoods trajectories of the double burden of disease using data from a cross-sectional neighborhood-based study in Ghana. We fitted multinomial multilevel multivariate models to a sample of 1377 individual surveys and the results presented as odds ratios. Findings show that amidst a rising burden of NCDs, infectious diseases remain the most common health condition and participants in deprived neighborhoods were significantly more likely to report poor health outcomes. Risk factors such as tobacco and alcohol consumption were significantly associated with NCDs and infectious diseases and respondents who reported being diagnosed with NCDs and infectious diseases in the past year were likely to engage in leisure time physical activities and eat healthy. Based on our findings, we recommend health reforms in Ghana and argue for the design and implementation of an integrated framework for the study and management of the double burden of disease in Ghana and similar developing country settings.

Prevalence of Clinical Cardiovascular Disease Risk Factors Among HIV Infected Patients on Anti-Retroviral Treatment in a Tertiary Hospital in Ethiopia

Background

Anti-retroviral treatment has improved mortality of human immunodeficiency virus (HIV) infected patients, which is offset by an increasing burden of cardiovascular diseases (CVD). Data regarding prevalence of cardiovascular disease risk factors in HIV infected patients in Ethiopia are very scarce. The aim of this study was to determine the prevalence of CVD risks and associated factors in patients with HIV.

Methods

A cross-sectional study was conducted on 333 patients with HIV infection, using a modified World Health Organization’s stepwise approach to surveillance questionnaire. Anthropometric and blood pressure measurement was done along with biochemical studies. Cardiovascular risk was estimated using Framingham risk score. Multivariate logistic regression was used to examine the association between cardiovascular risks and associated factors, with a p-value of <0.05 considered statistically significant.

Results

The mean age of the participants was 45 years, and 69.2% were females. Most (80.9%) of the participants had viral load below 50 copies/mL and the mean CD4 count was 579 cells/mm³. Dyslipidemia was the most common risk factor identified in 69.4%, followed by abnormal fasting blood glucose (≥100 mg/dL) in 36.8%. Hypertension was diagnosed in 23.8%, while 22.8% and 11.1% had metabolic syndrome and obesity, respectively. Framingham risk score was low in 95.9%. Male gender, increasing age, high body mass index and previous ART regimen being tenofovir disoproxil fumarate, lamivudine and nevirapine increased CVD risk factors.

Conclusion

Traditional cardiovascular risk factors were high in the population studied. There is a need to raise awareness about the risk factors, and patients should have timely follow-up and care.

Association of sickle cell trait with β-cell dysfunction and physical activity in adults living with and without HIV in Tanzania

This study aimed to investigate sickle cell trait (SCT) associations with physical activity, markers of insulin secretion and resistance, and glucose among people living with HIV infection (PLWH), both antiretroviral therapy (ART) naive and experienced, and HIV-uninfected adults. This was a cross-sectional study conducted in Mwanza, Northwestern Tanzania. We used data of 668 participants attained from two sub-studies of CICADA study. Mean age was 40 (SD 11.5) years, 402 (61.7%) were females and 157 (24.1%) had SCT. PLWH were 422 (64.7%), of these, 80 (18.9%) were on ART. People with SCT had higher risk of having an isolated β-cell dysfunction compared to those without SCT (RRR = 1.82, CI: 1.10, 3.01, p = 0.02). People with SCT but without HIV infection had lower average acceleration on the trunk longitudinal axis (ACCx) and higher level of self-reported physical activity. 30 min oral glucose tolerance test among PLWH on ART was higher in those with SCT compared to those without SCT. People with SCT are at higher risk of having β-cell dysfunction and those with SCT on ART are at more risk of developing diabetes. Future studies to investigate the interaction between SCT and HIV/ART on risk of diabetes should be considered.

Biomarkers and Prevalence of Cardiometabolic Syndrome Among People Living With HIV/AIDS, Addis Ababa, Ethiopia: A Hospital-Based Study

BACKGROUND

While the fast extension of combination antiretroviral therapy (cART) has resulted in significant increases in life expectancy, disorders such as cardiometabolic syndrome (CMetS), which have received less attention, are becoming a major concern in HIV/AIDS patients (PLWHA).

OBJECTIVES

The purpose of this research was to identify biomarkers and determine the prevalence of CMetS in PLWHA using the National Cholesterol Education Program (NCEP) and the International Diabetes Federation (IDF) tools.

METHODS

Between January 2019 and February 2021, a hospital-based study of HIV-infected patients (n = 288) was conducted. The data were analyzed using binary logistic regression. To control the effect of confounders, independent variables with a P-value of <.20 in the bivariate logistic regression were incorporated into multivariate logistic regression. Statistical significance was defined as a 95% confidence interval and a P-value of less than .05.

RESULTS

The risk of CMetS increased twofold as age increased each year (P = .009), 1.2 times as the age at which cART began increased (P = .015), and 6 times with 1 or more co-morbidities (P = .028), according to the NCEP tool. Furthermore, significant NCEP-CMetS correlations were produced by a rise in diastolic blood pressure (P < .001) and cART duration (P = .006). Male gender was 99.9% less likely to be related to CMetS using the IDF tool, and the risk of CMetS increased fourfold with each unit increase in waist circumference (P < .001). Triglycerides and blood type "A" have been found to have substantial relationships with CMetS using both techniques.

CONCLUSION

According to the study, CMetS was found to be common in PLWHA. Age, time on cART, age when cART started, gender, co-morbidities, waist circumference, and diastolic blood pressure were all revealed to be significant predictors of CMetS. Triglycerides and blood type "A" were the only biomarkers found to be significant with CMetS using both the NCEP and IDF tools.

Impact of Combined Antiretroviral Therapy on Metabolic Syndrome Components in Adult People Living with HIV: A Literature Review

The development of metabolic derangements as a result of HIV treatment has been an important area of research since the introduction of zidovudine in the 1980's. Antiretroviral therapy has intensely evolved in the last three decades, with new drugs gradually incorporated into everyday clinical practice. With the life expectancy of people living with HIV rapidly approaching that of their HIV-negative counterparts, the influence of these antiretrovirals on the development of the components of the metabolic syndrome remains of major interest to clinicians and their patients. In this review, we aimed to discuss the impact of cART on components of the metabolic syndrome, i.e., weight, plasma lipid levels, plasma glucose levels, and blood pressure, describing the influence of cART classes and of individual antiretrovirals. We also aimed to outline the limitations of the research conducted to date and the remaining knowledge gaps in this area.

Diabetes mellitus among adults on highly active anti-retroviral therapy and its associated factors in Ethiopia: Systematic review and meta-analysis

BACKGROUND

Diabetes mellitus occurs as a comorbid illness among people living with HIV and, in particular those on Highly Active Anti-retroviral therapies (HAART). Previous studies have documented the prevalence of diabetes mellitus among adults on HAART; however, there is lack of comprehensive estimation. Hence, this study was aimed to estimate the pooled prevalence and associated factors of diabetes mellitus among adults on HAART in Ethiopia.

METHODS

Primary studies were exhaustively searched using Cochrane, PubMed, Google Scholar, Scopus and Web of science databases until February 2021. Eligible studies were selected and critically appraised for quality using the Joanna Briggs Institute (JBI) quality appraisal checklist. The required data were extracted and exported to Stata version 16 for meta-analysis. The overall prevalence of diabetes mellitus among adults on HAART was estimated using a weighted inverse random effect model. Sensitivity and sub-group analysis were conducted for evidence of heterogeneity. Trim and fill analysis was performed after Egger's test and funnel plot were indicating the presence of publication bias.

RESULTS

A total of 17 studies with 6,052 subjects on HAART were included. The pooled prevalence of diabetes mellitus among patients on HAART was 16.04% [95% Confidence Interval (CI); 11.6, 20.92]. Abnormal High Density Lipoprotein Cholesterol (HDL-C) [Adjusted Odd Ratio (AOR) = 4.68, 95% CI; 2.54, 6.82], Body Mass Index (BMI) ≥ 25 kg/m² [AOR = 7.41, 95% CI; 2.75, 12.08], ≥6 years ART [AOR = 8.14, 95% CI; 5.85, 30.43], hypertension [AOR = 3.29, 95% CI; 2.13, 4.45], age 35-44 years [AOR = 6.28; 95% CI; 4.20, 8.37, BMI ≥ 30 kg/m² [AOR = 7.81, 95% CI; 4.97, 10.64], educational status above diploma [AOR = 6.42, 95% CI; 1.28, 11.57] and age 45-55 years [AOR = 4.46, 95% CI; 2.81, 6.10] were positively associated with diabetes mellitus comorbidity among adults on HAART.

CONCLUSION

The higher prevalence of diabetes mellitus was observed for adults on HAART. HDL-C, duration of ART, hypertension, overweight, obesity, age and educational status of participants increases the prevalence of diabetes mellitus. The study highlights the importance of timely screening of HDL-C level, blood pressure and BMI for adults on HAART.

Prevalence of diabetes mellitus and hypertension amongst the HIV-positive population at a district hospital in eThekwini, South Africa

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.

Cardiovascular risk factors among patients with human immunodeficiency viral infection at a tertiary hospital in Ghana: a cross-sectional study

Introduction

the provision of antiretroviral treatment (ART) to people living with HIV/AIDS (PLHIV) has improved their life expectancy significantly. Conversely, this has been associated with an elevated risk of cardiovascular diseases. Yet, research to improve understanding of cardiovascular risk factors among PLHIV remains limited. This study examines the prevalence and correlates of cardiovascular risk factors among PLHIV at the Korle Bu Teaching Hospital (KBTH) in Accra, Ghana.

Methods

a cross-sectional study was conducted at the KBTH, Accra, Ghana. Patients were recruited from the adult HIV outpatient clinic at the infectious disease unit, KBTH. The sample comprised 525 PLHIV, aged 18 years and above. Data were analysed using descriptive statistics and a multivariable binary logistic regression.

Results

among the patients, 9.7% (n=51) had hypertension and 15.6% (n=82) were reportedly patients with diabetes. With respect to the serum lipid profile, 24.8% (n=130) had hypertriglyceridemia, 49.1% (n=258) had hypercholesterolemia, 26.3% (138) had low high-density lipoprotein, and high low-density lipoprotein was found in 27.2% (n=143) of the cohort. The multivariable binary logistic regression results showed that being unemployed, underweight, being on ART, being male, having a higher level of education, and not having health insurance subscription significantly increased the odds of cardiovascular risk factors among the patients.

Conclusion

current findings buttress concern for elevated risk of cardiovascular diseases among PLHIV and calls for increased attention for comprehensive care that includes the prevention and management of cardiovascular diseases and its risk factors among this vulnerable group.

The Interaction of Diabetes and Tuberculosis: Translating Research to Policy and Practice

Diabetes Mellitus increases the risk of developing Tuberculosis (TB) disease by about three times; it also doubles the risk of death during TB treatment and other poor TB treatment outcomes. Diabetes may increase the risk of latent infection with Mycobacterium tuberculosis (LTBI), but the magnitude of this effect is less clear. Whilst this syndemic has received considerable attention, most of the published research has focussed on screening for undiagnosed diabetes in TB patients or observational follow-up of TB treatment outcomes by diabetes status. There are thus substantial research and policy gaps, particularly with regard to prevention of TB disease in people with diabetes and management of patients with TB-diabetes, both during TB treatment and after successful completion of TB treatment, when they likely remain at high risk of TB recurrence, mortality from TB and cardiovascular disease. Potential strategies to prevent development of TB disease might include targeted vaccination programmes, screening for LTBI and preventive therapy among diabetes patients or, perhaps ideally, improved diabetes management and prevention. The cost-effectiveness of each of these, and in particular how each strategy might compare with targeted TB prevention among other population groups at higher risk of developing TB disease, is also unknown. Despite research gaps, clinicians urgently need practical management advice and more research evidence on the choice and dose of different anti-diabetes medication and effective medical therapies to reduce cardiovascular risks (statins, anti-hypertensives and aspirin). Substantial health system strengthening and integration may be needed to prevent these at risk patients being lost to care at the end of TB treatment.

Prevalence and incidence of pre-diabetes and diabetes mellitus among people living with HIV in Ghana: Evidence from the EVERLAST Study

BACKGROUND

Available data from high-income countries suggest that people living with HIV (PLWH) have a four-fold higher risk of diabetes compared with HIV-negative people. In sub-Saharan Africa, with 80% of the global burden of HIV, there is a relative paucity of data on the burden and determinants of prevalent and incident dysglycaemia.

OBJECTIVES

To assess the prevalence and incidence of pre-diabetes (pre-DM) and overt diabetes mellitus (DM) among PLWH in a Ghanaian tertiary medical centre.

METHODS

We first performed a cross-sectional comparative analytical study involving PLWH on combination antiretroviral therapy (cART) (n = 258), PLWH not on cART (n = 244) and HIV-negative individuals (n = 242). Diabetes, pre-DM and normoglycaemia were defined as haemoglobin A1C (HBA1c) > 6.5%, in the range 5.7-6.4% and < 5.7% respectively. We then prospectively followed up the PLWH for 12 months to assess rates of new-onset DM, and composite of new-onset DM and pre-DM. Multivariate logistic regression models were fitted to identify factors associated with dysglycaemia among PLWH.

RESULTS

The frequencies of DM among PLWH on cART, PLWH not on cART and HIV-negative individuals were 7.4%, 6.6% and 7.4% (P = 0.91), respectively, while pre-DM prevalence rates were 13.2%, 27.9% and 27.3%, respectively (P < 0.0001). Prevalent DM was independently associated with increasing age [adjusted odds ratio (95% confidence interval) (aOR, 95% CI) = 1.82 (1.20-2.77) for each 10-year rise], male sex [aOR = 2.64 (1.20-5.80)] and log(triglyceride/HDL cholesterol) [aOR = 8.54 (2.53-28.83)]. Prevalent pre-DM was independently associated with being on cART [aOR (95% CI) = 0.35 (0.18-0.69)]. There were a total of 12 cases of incident DM over 359.25 person-years, giving 33.4/1000 person-years of follow-up (PYFU) (95% CI: 18.1-56.8/1000), and an rate of incident pre-DM of 212.7/1000 PYFU (95 CI: 164.5-270.9/1000). The two independent factors associated with new-onset DM were having pre-DM at enrolment [aOR = 6.27 (1.89-20.81)] and being established on cART at enrolment [aOR = 12.02 (1.48-97.70)].

CONCLUSIONS

Incidence rates of pre-DM and overt DM among Ghanaian PLWH on cART ranks among the highest in the literature. There is an urgent need for routine screening and a multidisciplinary approach to cardiovascular disease risk reduction among PLWH to reduce morbidity and mortality from the detrimental effects of dysglycaemia.

HIV, Antiretroviral Therapy and Metabolic Alterations: A Review

The introduction of antiretroviral therapy (ART) has caused some metabolic problems to people who suffer from HIV. ART probably is not the sole reason for these metabolic disorders. Most likely, HIV itself affects the metabolism as well. We conducted research to find the prevalence of the different types of metabolic disorders among HIV(+) patients. Female gender, high BMI, and older age are among the risk factors for the occurrence of metabolic disorders. Regarding dyslipidemia, hypertriglyceridemia and low high-density lipoproteins (HDLs) are the most common types of dyslipidemia in the studies we included. Protease inhibitors (PIs) are widely known as the most common class of antiretroviral drugs that cause metabolic disorders, and some studies in our review also demonstrated this knowledge. In our review, we concluded that HIV and ART concurrently alter the metabolism, but further research is required about this substantial topic.

Diabetes mellitus and its associated risk factors in patients with human immunodeficiency virus on anti-retroviral therapy at referral hospitals of Northwest Ethiopia

BACKGROUND

The use of highly active anti- retroviral therapy (HAART) as well as human immunodeficiency virus (HIV) per se have been shown to be related with diabetes among patients living with HIV. There is limited evidence on the prevalence of diabetes among HIV-infected patients in developing countries like Ethiopia. Therefore, the aim of this study is to determine the prevalence of diabetes among patients living with HIV/AIDS at referral hospitals of Northwest Ethiopia.

MATERIALS AND METHODS

a hospital based cross-sectional study was conducted at referral hospitals of Northwest Ethiopia between February 2019 and April 2019. Using WHO stepwise approach, sociodemographic, behavioral and clinical data were collected from 407 included adult patients. Simple random sampling methods was used to select the study participants. Lipid profiles, fasting blood sugar as well as anthropometric indicators were also measured. SPSS version 25 was used for analysis of data; bivariate and multivariate binary logistic regression analysis was performed.

RESULT

From a total of 415 patients living with HIV deemed eligible for inclusion, 407 with complete data were included in the final analysis giving a response rate of 98%. From 407 study subjects included in the analysis, 161 (39.6%) were men. The prevalence of diabetes mellitus was found to be 8.8% (95% CI 6.05, 11.55). Multivariate logistic regression analysis revealed that age [AOR (95% CI) 1.04 (1.001,1.084), p < 0.05], educational status [AOR (95% CI) 6.27 (1.72, 22.85), p < 0.05, diploma; AOR (95% CI) 9.64 (2.57, 36.12), p < 0.05, degree and above], triglyceride level [AOR (95% CI) 1.007 (1.003, 1.010), p < 0.01] have shown statistically significant association with odds of diabetes mellitus.

CONCLUSION

The prevalence of diabetes was notably high in patients living with HIV/AIDS. Factors such as increased age, educational status and higher level of serum triglyceride were found to contribute to this high prevalence of diabetes.

Hypertension in HIV-Infected Patients Receiving Antiretroviral Therapy in Northeast Ethiopia

Background

With prolonged survival and aging of persons with HIV on combination antiretroviral therapy (ART), hypertension has emerged as a significant cause of morbidity and mortality globally. However, little is known about the burden of this comorbid condition among adults living with HIV in sub-Saharan Africa. In this study, we aimed to determine the prevalence and factors associated with hypertension among HIV-infected patients receiving ART in Northeast Ethiopia.

Methods

A cross-sectional study was conducted at the ART clinic of Dessie Referral Hospital, Northeast Ethiopia, between January and May 2018. HIV-infected patients who were on ART for at least 12 months were included in the study. Demographic, clinical, and laboratory data were collected from each participant. Hypertension was defined as a systolic blood pressure (BP) of ≥140 mmHg and/or diastolic BP of ≥90 mmHg or a reported use of antihypertensive medication. Univariable and multivariate analyses were performed to identify factors associated with hypertension.

Results

A total of 408 patients were studied with a mean (±SD) age of 37 ± 10.3 years, and 66.9% were female. The prevalence of hypertension was 29.7% (95% CI, 25.3–35.0%). Nearly 75% of the patients with hypertension were previously undiagnosed. In a univariate analysis, older age, male gender, a family history of hypertension, duration of HIV infection, duration on ART, high body mass index, low CD4 count, diabetes, and renal impairment were associated with hypertension. Multivariate analysis revealed older age (AOR = 2.08; 95% CI, 1.13–3.83), male gender (AOR = 1.64; 95% CI, 1.01–2.65), longer duration on ART (AOR = 1.91; 95% CI, 1.14–3.20), high body mass index (AOR = 3.32; 95% CI, 1.13–9.77), and diabetes (AOR = 2.76; 95% CI, 1.29–5.89) as independent risk factors of hypertension.

Conclusions

Hypertension is highly prevalent among HIV-infected patients on ART attending our clinic in Northeast Ethiopia but is mostly undiagnosed. These findings highlight the need for integrating hypertension management into routine HIV care to prevent adverse outcomes and improve health of people living with HIV on ART.

Diabetes Mellitus and Its Association with Hypertension in Ethiopia: A Systematic Review and Meta-Analysis

BACKGROUND

Diabetes mellitus (DM) is a growing public health concern globally, including Ethiopia. Although numerous studies have been published from different parts of Ethiopia, no attempt is made so far to estimate the burden of DM at the national level. This study aims to estimate the pooled prevalence of DM and its association with hypertension in Ethiopia.

METHODS

A systematic search was conducted in major databases. Two authors extracted the necessary data and analysis was conducted using STATA version 14. Heterogeneity across the studies was evaluated by Cochran's Q test and I² statistics.

RESULTS

Eighteen studies with a total of 45,284 participants were included in this review. The pooled prevalence of DM was 4.99% (95% CI: 3.86%, 6.11%). Hypertension was significantly associated with DM (OR: 8.32; 95% CI: 3.05, 22.71).

CONCLUSION

The burden of DM in Ethiopia is considerable, and the association between diabetes and hypertension is significant. Based on the evidence, this review recommends establishing the coordinated national programs that counteract the increasing burden of DM in the country is very essential. In addition, Early hypertension screening should be done in diabetic patients to control co-morbidity and further complications.

C - reactive protein and interleukin - 6 levels among human immunodeficiency virus -infected patients with dysglycemia in Tanzania

BACKGROUND

Chronic inflammation has been associated with dysglycemia among people living with HIV (PLHIV). There is however, limited data regarding this phenomenon in sub-Sahara Africa (SSA). Therefore we assessed the levels of C-reactive protein (CRP) and Interleukin 6 (IL-6) on a cohort of PLHIV and its associations with dysglycemia in Tanzania.

METHODS

We conducted a cross-sectional study at the Infectious Disease Clinic (IDC) in Tanzania from March to May 2018. Purposive sampling was used to identify participants who had an undetectable viral load, were on 1st line anti-retroviral therapy (ART) and had an overnight fast. The WHO stepwise approach for non-communicable disease (NCD) surveillance was used to collect data. Fasting blood glucose and blood glucose after 75 g oral glucose load was measured, and Enzyme-linked immunosorbent assay (ELISA) was used to test for inflammatory markers (IL-6 and CRP). Associations were explored using the Chi square test and binary logistic regression was performed to estimate the odds ratios. A p-value less than 0.05 was considered statistically significant.

RESULTS

A total of 240 participants were enrolled. Forty two percent were overweight/obese (> 25 kg/m²), 89% had a high waist to height ratio. The median ART duration was 8(5-10) years. The prevalence of dysglycemia among our cohort of PLHIV was 32%. High CRP was associated with a 2.05 increased odds of having dysglycemia OR 2.05 (1.15-3.65) (p = 0.01). Taking stavudine was associated with a 1.99 odds of having dysglycemia OR 1.99 (1.04-3.82) (p = 0.03).We did not find a significant association between IL-6 and dysglycemia.

CONCLUSION

High CRP and taking stavudine were significantly associated with dysglycemia among PLHIV with undetectable viral load.

Diabetes mellitus and its associated factors among human immunodeficiency virus-infected patients on anti-retroviral therapy in Northeast Ethiopia

Objective

The aim of this study was to determine the prevalence of diabetes mellitus and its associated factors among human immunodeficiency virus-infected patients on anti-retroviral therapy in Northeast Ethiopia.

Results

A facility based cross-sectional study was conducted among 408 HIV-infected adults (≥ 18 years old) attending an ART clinic in Northeast Ethiopia from January to March 30, 2018. The mean (± SD) age of studied patients was 37 ± 10.3 years, and 273 (66.9%) were female. Of the total participants, 36 (8.8%, 95% CI 6.4% to 11.8%) had diabetes and 61 (15.0%, 95% CI 11.5% to 18.6%) had impaired fasting glucose level (111–125 mg/dl). Only fourteen (3.4%) participants knew their diabetes status during data collection. In the multivariate analysis, older age (age > 45 years; AOR = 3.51, 95% CI 1.52–8.10, P = 0.003), a family history of diabetes (AOR = 6.46, 95% CI 3.36–21.29, P < 0.001), duration of ART (AOR = 2.67, 95% CI 1.16–6.17, P = 0.021), and hypertension (AOR = 2.62, 95% CI 1.20–5.72, P = 0.016) were independently associated with increased odds of diabetes. These results highlight the need for regular diabetes screening among HIV-infected patients on ART in order to prevent or reduce disease-related outcomes of these patients in this study setting.

Electronic supplementary material

The online version of this article (10.1186/s13104-019-4402-1) contains supplementary material, which is available to authorized users.

Hypertension and Diabetes Mellitus among Patients at Hawassa University Comprehensive Specialized Hospital, Hawassa, Southern Ethiopia

Background

The burden of noncommunicable disease (NCD) in Africa is on a remarkable rise exacerbating the poor public health status affected by the existing but yet unsolved communicable disease. In Ethiopia, there is a paucity of evidence regarding prevalence and risk factors to NCD.

Objective

This study sought to determine the prevalence of risk factors of NCDs, prevalence of DM and HTN, and risk factors associated with diabetes mellitus (DM) and hypertension (HTN).

Method

This is an institution based cross-sectional study conducted on a sample of 411 clients attending a university-based comprehensive specialized hospital in Southern Ethiopia. The data was collected by using a pretested interviewer-administered questionnaire and observational checklist. Frequency, proportions, bivariate and multivariate logistic regression analysis was conducted using SPSS software version 20.

Result

We identified 64.2% of the clients had at least one of the risk factors to the NCDs. One-third (33.3%) had physical inactivity, whereas 20.2% had a BMI of ≥ 25%. The prevalence of DM and HTN was 12.2% and 10.5%, respectively. The multivariate analysis demonstrated that age ≥ 60 years, physical inactivity, higher BMI, and cigarette smoking were risk factors for at least one of the NCDs.

Conclusion

The prevalence of DM and prevalence of HTN were high. The magnitudes of risk factors to NCDs among the study population were substantial. Higher BMI, physical inactivity, low fruit and vegetable consumption, alcohol use, khat chewing, and cigarette smoking were among the prevailing risk factors identified.

Magnitude and associated factors of diabetes mellitus and hypertension among adult HIV-positive individuals receiving highly active antiretroviral therapy at Jugal Hospital, Harar, Ethiopia

BACKGROUND

People with HIV infection are at increased risk of noncommunicable diseases (NCDs). Diabetes mellitus (DM) and hypertension are recognized as the major NCDs. Except few findings in general population, there is no well-documented evidence on the magnitude of NCDs and associated factors among HIV-positive patients.

PURPOSE

The aim of this study was to determine the magnitude and associated factors of DM and hypertension among adult HIV-positive subjects receiving highly active antiretroviral therapy (HAART).

METHODS

A hospital-based cross-sectional study was conducted from February to April at Jugal Hospital, Harar, Eastern Ethiopia. Sociodemographic and anthropometric data and blood pressure (BP) were collected by senior clinical nurses. A total of 5 mL of venous blood was collected. Serum glucose and lipid profile were measured using the Autolab 18 clinical chemistry analyzer. Data were analyzed using STATA version 13.

RESULTS

A total of 425 HIV-infected individuals taking HAART of age ranging from 18 to 68 years were included. The prevalence of DM and hypertension were 7.1% (95% CI: 4.9-9.9) and 12.7% (95% CI: 9.8-16.2), respectively. Increased blood triglyceride (adjusted odds ratio [AOR] =4.7, 95% CI: 1.7-13.1), high BP (AOR =3.3, 95% CI: 1.1-9.5), and high baseline body mass index (BMI) (AOR =8.7, 95% CI: 2.4-31.8) were significantly associated with DM. In contrast, raised waist-hip ratio (AOR =4.6, 95% CI: 1.6-13.3), raised blood glucose (AOR =3.5, 95% CI: 1.1-11.4), increased total cholesterol (AOR =3.9, 95% CI: 1.3-11.9), high current BMI (AOR =3.8, 95% CI: 1.5-9.6), drinking alcohol (AOR =3.4, 95% CI: 1.5-8.1), CD4 count <500 cell/mL (AOR =2.7, 95% CI: 1.3-5.6), and longer duration of HAART (AOR =2.3, 95% CI: 1.1-5.1) were significantly associated with hypertension.

CONCLUSION

DM and hypertension were frequent among HIV patients on HAART, and they were linked to the well-known risk factors. Therefore, regular screening and monitoring of DM and hypertension before and after the initiation of HAART is of paramount importance.

The association between antiretroviral therapy and selected cardiovascular disease risk factors in sub-Saharan Africa: A systematic review and meta-analysis

BACKGROUND

With increasing adverse cardiovascular disease (CVD) outcomes in HIV/AIDS patients, the possible contribution of antiretroviral therapy (ART) to the prevailing CVD epidemic in sub-Saharan Africa (SSA) through its effect on CVD risk factors has rather been under investigated. This study aimed to assess the extent to which ART is associated with hypertension, diabetes mellitus (DM) and dyslipidemia in SSA.

METHODS

This is a systematic review and meta-analysis of studies from SSA, published between January 1946 and December 2017, from Medline, Embase, Africa-wide Information, the Cochrane library, African Index and Medicus databases. Both observational and interventional studies with comparable ART-treated and ART-naïve populations were selected and data was extracted from eligible studies. Pooled estimates of the effect of ART on the outcomes of interest (hypertension, diabetes and abnormal lipid profiles) were obtained using random effects meta-analysis, and meta-regression analysis was used to explore between-study heterogeneity.

RESULTS

Twenty cross-sectional studies were included involving 5386 participants. There was no association between ART use and hypertension (OR: 1.9, 95%CI: 0.96-3.76, n = 8, I2 = 73.8%) and DM (OR: 2.53, 95%CI: 0.87-7.35, n = 8, I2 = 73.8%). ART use was associated with high total cholesterol (OR: 3.85, 95%CI: 2.45-6.07, n = 8, I2 = 67.0%), high triglycerides (OR: 1.46, 95%CI: 1.21-1.75, n = 14, I2 = 10.0%) and high LDL-cholesterol (OR: 2.38, 95%CI: 1.43-3.95, n = 11, I2 = 87.6%). ART was associated with rather lower odds of having low HDL-cholesterol (OR: 0.53, 95%CI: 0.32-0.87, n = 8, I2 = 78.2%). There was evidence of between-study heterogeneity for all outcomes except high triglycerides.

CONCLUSIONS

ART appears to be associated with CVD risk in HIV/AIDS patients in SSA only through dyslipidemia but not through hypertension and DM, however, high quality and robust research in SSA is mandated to accurately ascertain the actual contribution of ART to the CVD burden in this part of the world. Nevertheless, HIV/AIDS patients should still benefit from systematic CVD screening alongside their regular care services.

TRIAL REGISTRATION

Prospero Registration - CRD42016042306.

Immune reconstitution in ART treated, but not untreated HIV infection, is associated with abnormal beta cell function

HIV infection has been associated with increased diabetes risk, but prior work has mostly focused on insulin resistance, as opposed to beta cell effects, or included patients on antiretroviral therapies (ART) directly linked to metabolic toxicity. In this analysis, we measured markers of glucose homeostasis and beta cell function, stress, and death in fasting sera from a cross section of HIV+ individuals off ART (n = 43), HIV+ individuals on ART (n = 23), and HIV- controls (n = 39). Markers included glucose, HOMA%S, HOMA%B, proinsulin:C-peptide ratio (PI:C ratio), and circulating preproinsulin (INS) DNA. We performed multiple linear regressions with adjustments for age, sex, race, BMI, and smoking status. Compared to HIV- controls, HIV+ participants off ART exhibited similar beta cell function and insulin sensitivity, without increases in markers of beta cell stress or death. Specifically, in HIV+ participants with CD4 counts <350 cells/μL, PI:C ratios were lower than in HIV- controls (p<0.01), suggesting a reduction in intrinsic beta cell stress among this group. By contrast, HIV+ participants on ART had higher fasting glucose (p<0.0001) and lower HOMA%B (p<0.001) compared to HIV- controls. Among the entire HIV+ population, higher HIV RNA correlated with lower fasting glucose (r = -0.57, p<0.001), higher HOMA%B (r = 0.40, p = 0.001), and lower PI:C ratios (r = -0.42, p<0.001), whereas higher CD4 counts correlated with higher PI:C ratios (r = 0.2, p = 0.00499). Our results suggest that HIV seropositivity in the absence of ART does not worsen beta cell function or glucose homeostasis, but immune reconstitution with ART may be associated with worsened beta cell function.

Prevalence, Risk Factors, and Pathophysiology of Dysglycemia among People Living with HIV in Sub-Saharan Africa

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.

Is there sufficient evidence for a causal association between antiretroviral therapy and diabetes in HIV-infected patients? A meta-analysis

The association of antiretroviral therapy (ART) with diabetes is inconsistent and varies widely across primary epidemiological studies. A comprehensive and more precise estimate of this association is fundamental to establishing a plausible causal link between ART and diabetes. We identified epidemiological studies that compared mean fasting plasma glucose (FPG) concentrations and proportions of diabetes and metabolic syndrome between HIV-infected patients naïve and exposed to ART. Mean difference in FPG concentrations and odds ratios of diabetes and metabolic syndrome were pooled using random-effects meta-analyses. Data on 20 178 participants from 41 observational studies were included in the meta-analyses. Mean FPG concentrations (Pooled mean difference: 4.66 mg/dL; 95% confidence interval [CI], 2.52 to 6.80; 24 studies) and the odds of diabetes (Pooled odds ratios: 3.85; 95% CI, 2.93 to 5.07; 10 studies) and metabolic syndrome (Pooled odds ratios: 1.45; 95% CI, 1.03 to 2.03; 18 studies) were significantly higher among ART-exposed patients, compared to their naïve counterparts. ART was also associated with significant increases in FPG levels in studies with mean ART duration ≥18 months (Pooled mean difference: 4.97 mg/dL; 95% CI, 3.10 to 6.84; 14 studies), but not in studies with mean ART duration <18 months (Pooled mean difference: 4.40 mg/dL, 95% CI, -0.59 to 9.38; 7 studies). ART may potentially be the single most consistent determinant of diabetes in people living with HIV worldwide. However, given the preponderance of cross-sectional studies in the meta-analysis, the association between ART and diabetes cannot be interpreted as cause and effect.

Global prevalence of hypertension among people living with HIV: a systematic review and meta-analysis

The purpose of this study was to estimate, through meta-analysis, the global prevalence of hypertension among people living with HIV (PLWH). A total of 49 studies published during 2011-2016 with 63,554 participants were included in analysis. These studies were conducted in America (25), Europe (13), Africa (10), and Asia (1) with data collected during 1996-2014. Prevalence of hypertension and confidence interval was estimated and stratified by participants' age, antiretroviral therapy (ART), and calendar-years using random effects modeling. The quality assessed using the Joanna Briggs Institute Prevalence Critical Appraisal Tool was high for all included studies. The estimated prevalence (95% confidence interval) of hypertension was 25.2% (21.2%, 29.6%) for the overall sample, 34.7% (27.4%, 42.8%) for ART-experienced, and 12.7% (7.4%, 20.8%) for ART-naïve participants. The estimated prevalence was found increased with age and in studies conducted after 2010. Hypertension among PLWH shows an increasing trend and is associated with receiving ART and older age. Findings of this study provide data for decision makers to incorporate blood pressure assessment in primary prevention and for researchers to further investigate factors and mechanisms related to hypertension among PLWH.

The global diabetes epidemic: what does it mean for infectious diseases in tropical countries?

Tropical countries are experiencing a substantial rise in type 2 diabetes, which is often undiagnosed or poorly controlled. Since diabetes is a risk factor for many infectious diseases, this increase probably adds to the large infectious disease burden in tropical countries. We reviewed the literature to investigate the interface between diabetes and infections in tropical countries, including the WHO-defined neglected tropical diseases. Although solid data are sparse, patients with diabetes living in tropical countries most likely face increased risks of common and health-care-associated infections, as well as infected foot ulcers, which often lead to amputation. There is strong evidence that diabetes increases the severity of some endemic infections such as tuberculosis, melioidosis, and dengue virus infection. Some HIV and antiparasitic drugs might induce diabetes, whereas helminth infections appear to afford some protection against future diabetes. But there are no or very scarce data for most tropical infections and for possible biological mechanisms underlying associations with diabetes. The rise in diabetes and other non-communicable diseases puts a heavy toll on health systems in tropical countries. On the other hand, complications common to both diabetes and some tropical infections might provide an opportunity for shared services-for example, for eye health (trachoma and onchocerciasis), ulcer care (leprosy), or renal support (schistosomiasis). More research about the interaction of diabetes and infections in tropical countries is needed, and the infectious disease burden in these countries is another reason to step up global efforts to improve prevention and care for diabetes.

Incidence and prevalence of type 2 diabetes mellitus with HIV infection in Africa: a systematic review and meta-analysis

OBJECTIVES

This systematic review aims to investigate the incidence and prevalence of type 2 diabetes mellitus (T2DM) in patients with HIV infection in African populations.

SETTING

Only studies reporting data from Africa were included.

PARTICIPANTS

A systematic search was conducted using four databases for articles referring to HIV infection and antiretroviral therapy, and T2DM in Africa. Articles were excluded if they reported data on children, animals or type 1 diabetes exclusively.

MAIN OUTCOME MEASURES

Incidence of T2DM and prevalence of T2DM. Risk ratios were generated for pooled data using random effects models. Bias was assessed using an adapted Cochrane Collaboration bias assessment tool.

RESULTS

Of 1056 references that were screened, only 20 were selected for inclusion. Seven reported the incidence of T2DM in patients with HIV infection, eight reported the prevalence of T2DM in HIV-infected versus uninfected individuals and five reported prevalence of T2DM in HIV-treated versus untreated patients. Incidence rates ranged from 4 to 59 per 1000 person years. Meta-analysis showed no significant differences between T2DM prevalence in HIV-infected individuals versus uninfected individuals (risk ratio (RR) =1.61, 95% CI 0.62 to 4.21, p=0.33), or between HIV-treated patients versus untreated patients (RR=1.38, 95% CI 0.66 to 2.87, p=0.39), and heterogeneity was high in both meta-analyses (I²=87% and 52%, respectively).

CONCLUSIONS

Meta-analysis showed no association between T2DM prevalence and HIV infection or antiretroviral therapy; however, these results are limited by the high heterogeneity of the included studies and moderate-to-high risk of bias, as well as, the small number of studies included. There is a need for well-designed prospective longitudinal studies with larger population sizes to better assess incidence and prevalence of T2DM in African patients with HIV. Furthermore, screening for T2DM using gold standard methods in this population is necessary.

TRIAL REGISTRATION NUMBER

PROSPERO42016038689.

Diabetes mellitus among HIV-infected individuals in follow-up care at University of Gondar Hospital, Northwest Ethiopia

OBJECTIVE

To assess the prevalence of diabetes mellitus (DM) and associated factors among HIV-infected adults in northwest Ethiopia.

DESIGN

Hospital-based cross-sectional study.

SETTING

HIV clinic of the University of Gondar Hospital, Ethiopia.

PARTICIPANTS

All HIV-infected adults who visited the HIV clinic from December 2013 to the end of February 2014 were the source population.

MEASURES

A structured and pretested questionnaire incorporating the WHO STEPwise approach was used. A multivariate logistic regression analysis was applied to assess factors associated with DM.

RESULTS

The overall prevalence of type 2 DM was 8% (95% CI 5.5% to 10.5%). The prevalence of DM was higher (13.2%; 95% CI 8.0% to 18.3%) among subjects receiving pre-antiretroviral treatment (pre-ART) than among those taking ART (5.1%; 95% CI 2.6% to 7.6%). Thirteen (35.1%) of the DM cases were newly identified during the study. Obesity (adjusted OR (AOR) 6.55; 1.20 to 35.8), hypertension (AOR 3.45; 1.50 to 7.90), being in the pre-ART group (AOR 4.47; 1.80 to 11.08), hypertriglyceridaemia (AOR 2.24; 1.02 to 49.5) and tertiary-level education (AOR 11.8; 2.28 to 61.4) were associated with DM.

CONCLUSIONS

Overall DM prevalence was high, particularly among subjects in the pre-ART group. More educated, hypertensive and obese HIV-infected adults were more likely to have DM as a comorbidity. Health policy and the clinical management of HIV-infected individuals should take into account the rising DM.