1
|
Daultrey H, Levett T, Oliver N, Vera J, Chakera AJ. HIV and type 2 diabetes: An evolving story. HIV Med 2024; 25:409-423. [PMID: 38111214 DOI: 10.1111/hiv.13595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 11/17/2023] [Indexed: 12/20/2023]
Abstract
INTRODUCTION Diabetes is widely reported to be more common in people living with HIV (PLWH). Much of the data supporting this originated during the earlier HIV era. The perceived increased risk of type 2 diabetes is reflected in HIV clinical guidelines that recommend screening for diabetes in PLWH on anti-retroviral therapy (ART). However, international HIV clinical guidelines do not agree on the best marker of glycaemia to screen for diabetes. This stems from studies that suggest HbA1c underestimates glycaemia in PLWH. METHODS Within this review we summarise the literature surrounding the association of HIV and type 2 diabetes and how this has changed over time. We also present the evidence on HbA1c discrepancy in PLWH. CONCLUSION We suggest there is no basis to any international guidelines to restrict HbA1c based on HIV serostatus. We recommend, using the current evidence, that PLWH should be screened annually for diabetes in keeping with country specific guidance. Finally, we suggest future work to elucidate phenotype and natural history of type 2 diabetes in PLWH across all populations.
Collapse
Affiliation(s)
| | - Tom Levett
- Brighton and Sussex Medical School, Brighton, UK
| | | | - Jaime Vera
- Brighton and Sussex Medical School, Brighton, UK
| | | |
Collapse
|
2
|
Khunti K, Chudasama YV, Gregg EW, Kamkuemah M, Misra S, Suls J, Venkateshmurthy NS, Valabhji J. Diabetes and Multiple Long-term Conditions: A Review of Our Current Global Health Challenge. Diabetes Care 2023; 46:2092-2101. [PMID: 38011523 DOI: 10.2337/dci23-0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/26/2023] [Indexed: 11/29/2023]
Abstract
Use of effective treatments and management programs is leading to longer survival of people with diabetes. This, in combination with obesity, is thus contributing to a rise in people living with more than one condition, known as multiple long-term conditions (MLTC or multimorbidity). MLTC is defined as the presence of two or more long-term conditions, with possible combinations of physical, infectious, or mental health conditions, where no one condition is considered as the index. These include a range of conditions such as cardiovascular diseases, cancer, chronic kidney disease, arthritis, depression, dementia, and severe mental health illnesses. MLTC has major implications for the individual such as poor quality of life, worse health outcomes, fragmented care, polypharmacy, poor treatment adherence, mortality, and a significant impact on health care services. MLTC is a challenge, where interventions for prevention and management are lacking a robust evidence base. The key research directions for diabetes and MLTC from a global perspective include system delivery and care coordination, lifestyle interventions and therapeutic interventions.
Collapse
Affiliation(s)
- Kamlesh Khunti
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, U.K
| | - Yogini V Chudasama
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, U.K
| | - Edward W Gregg
- School of Population Health, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | - Monika Kamkuemah
- Innovation Africa and Department of Architecture, Faculty of Engineering, Built Environment and Information Technology, University of Pretoria, Pretoria, South Africa
| | - Shivani Misra
- Division of Metabolism, Digestion and Reproduction, Imperial College London, London, U.K
- Department of Diabetes and Endocrinology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, U.K
| | - Jerry Suls
- Institute for Health System Science, Feinstein Institutes for Medical Research Northwell Health, New York, NY
| | - Nikhil S Venkateshmurthy
- Public Health Foundation of India, New Delhi, India
- Centre for Chronic Disease Control, New Delhi, India
| | - Jonathan Valabhji
- Division of Metabolism, Digestion and Reproduction, Imperial College London, London, U.K
- Department of Diabetes and Endocrinology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, U.K
| |
Collapse
|
3
|
Galaviz KI, Schneider MF, Tien PC, Althoff KN, Ali MK, Ofotokun I, Brown TT. Expanding the Finnish Diabetes Risk Score for Predicting Diabetes Incidence in People Living with HIV. AIDS Res Hum Retroviruses 2021; 37:373-379. [PMID: 33683149 DOI: 10.1089/aid.2020.0247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This study investigated whether the predictive ability of the Finnish Diabetes Risk Score (FINDRISC) can be improved among people with HIV by adding a marker of insulin resistance. In this longitudinal analysis of the Multicenter AIDS Cohort Study and the Women's Interagency HIV Study, HIV-positive and HIV-negative participants without prevalent diabetes were included. FINDRISC score and the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) were calculated at baseline. Cox proportional hazards models were used to examine associations between baseline risk scores and time to incident diabetes (first self-report of diabetes medication use). Model discrimination (Uno's c-statistic) and calibration (observed vs. cumulative probability of diabetes) were assessed for FINDRISC, HOMA-IR, and combined FINDRISC and HOMA-IR. Overall, 2,527 men (1,299 HIV-positive and 1,228 HIV-negative, median age = 44) and 2,446 women (1,841 HIV-positive and 605 HIV-negative, median age = 41) were included. Over 47,040 person-years of follow-up, diabetes incidence rates per 1,000 person-years were 9.5 in HIV-positive men, 7.1 in HIV-negative men, 14.5 in HIV-positive women, and 15.1 in HIV-negative women. FINDRISC discrimination (HIV-positive men c = 0.64 [0.55, 0.74], HIV-negative men c = 0.74 [0.68, 0.79], HIV-positive women c = 0.68 [0.64, 0.71], and HIV-negative women c = 0.73 [0.66, 0.79]) was significantly better than that of HOMA-IR. FINDRISC was better calibrated than HOMA-IR in each of the four groups. Adding HOMA-IR did not improve FINDRISC discrimination/calibration. Diabetes risk prediction with FINDRISC was suboptimal in men and women with HIV, and its performance was not improved with addition of HOMA-IR. The optimal method for identifying people living with HIV at-risk for diabetes is yet to be identified.
Collapse
Affiliation(s)
| | - Michael F. Schneider
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Phyllis C. Tien
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Keri N. Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Mohammed K. Ali
- Department of Family and Precentive Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Igho Ofotokun
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Todd T. Brown
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Division of Endocrinology and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
4
|
Corbacho N, Mur I, Molas ME, Vidal F, Domingo P. The pharmacological management of cardiovascular disease in people living with HIV (PLWH). Expert Opin Pharmacother 2021; 22:743-753. [PMID: 33283570 DOI: 10.1080/14656566.2020.1856075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
ABSTARCTIntroduction: Cardiovascular disease (CVD) continues to be an essential cause of morbidity and mortality among people living with human immunodeficiency virus infection (PLWH). Since the bulk of cardiovascular risk (CVR) factors are shared between PLWH and the general population, prevention and treatment strategies are similar. However, there are CVR factors particular to PLWH, which need separate consideration. These factors are those HIV-dependent, those related to HIV-derived consequences, and combination antiretroviral therapy (cART)-dependent.Areas covered: In this review, the authors discuss the management of CVD in PLWH, with a special interest in pharmacological treatment and drug-drug interactions with cART.Expert opinion: In recent years, we have witnessed a decreased CVD morbidity and mortality in PLWH, which probably reflects an improvement in the management of CVR factors and CVD in these patients, partially thanks to new developments in antiretroviral therapy. Therefore, although there is still room for improvement, at present, the old desideratum of equaling PLWH and the general population in terms of CVD incidence and prognosis is a little closer.
Collapse
Affiliation(s)
- Noemí Corbacho
- From the Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Institut de Recerca del Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Isabel Mur
- From the Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Institut de Recerca del Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Maria Ema Molas
- From the Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Institut de Recerca del Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Pere Domingo
- From the Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Institut de Recerca del Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| |
Collapse
|
5
|
Kodiatte A, John M, Jacob JJ. Diabetes mellitus and prediabetes among patients with tuberculosis in a single north Indian tertiary care centre. J R Coll Physicians Edinb 2020; 50:242-246. [PMID: 32936096 DOI: 10.4997/jrcpe.2020.306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Prevalence of diabetes mellitus (DM), though believed to be high among patients with tuberculosis (TB), remains unclear for the want of systematic studies and unequivocal methods of diagnosing DM. This study was done to determine the prevalence of prediabetes and DM in adult patients with TB. METHODS This prospective study of one year's duration, carried out at a tertiary care centre included 313 consecutive adult patients diagnosed (either microbiologically, histologically or based on clinical presentation) with pulmonary or extrapulmonary TB. Those without a history of pre-existing DM were subjected to oral glucose tolerance test (OGTT) with 75 g glucose. RESULTS In this cohort 85 (27%) patients had pre-existing DM. The remaining 228 patients not diagnosed earlier with DM underwent a 75 g OGTT, of which 63 (28%) were found to have newly detected prediabetes (impaired fasting glucose [IFG] and impaired glucose tolerance [IGT] alone in 36 and 10 patients respectively and both IFG and IGT in a further 17) and DM was diagnosed in 9 (4%) patients (fasting blood glucose [FBG] ˜ 126 mg/dl in 1 and both FBG ˜ 126 mg/dl and 2-h plasma blood glucose [PLBG] ˜ 200 mg/dl in 8 patients). The total prevalence of (newly diagnosed) DM and prediabetes, therefore, was 32% (72 patients); the overall prevalence of DM was 30% (94 patients). CONCLUSION This study found high prevalence of prediabetes and diabetes among patients with TB. This underscores the need for a bidirectional screening strategy to improve diagnosis and outcome of both TB and DM.
Collapse
Affiliation(s)
- Abraham Kodiatte
- Department of Endocrinology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Mary John
- Department of Endocrinology, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - Jubbin Jagan Jacob
- Department of Endocrinology, Christian Medical College and Hospital, Ludhiana, Punjab, India,
| |
Collapse
|
6
|
Gebrie A, Tesfaye B, Gebru T, Adane F, Abie W, Sisay M. Diabetes mellitus and its associated risk factors in patients with human immunodeficiency virus on anti-retroviral therapy at referral hospitals of Northwest Ethiopia. Diabetol Metab Syndr 2020; 12:20. [PMID: 32158504 PMCID: PMC7057570 DOI: 10.1186/s13098-020-00527-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 02/24/2020] [Indexed: 12/12/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Alemu Gebrie
- Department of Biomedical Science, School of Medicine, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Bekele Tesfaye
- Department of Nursing, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Tensae Gebru
- Department of Biochemistry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Fentahun Adane
- Department of Biomedical Science, School of Medicine, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Worku Abie
- Department of Biomedical Science, School of Medicine, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Mekonnen Sisay
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia
| |
Collapse
|
7
|
Olasile IO, Jegede IA, Ugochukwu O, Ogedengbe OO, Naidu ECS, Peter IA, Azu OO. Histo-morphological and seminal evaluation of testicular parameters in diabetic rats under antiretroviral therapy: interactions with Hypoxis hemerocallidea. IRANIAN JOURNAL OF BASIC MEDICAL SCIENCES 2018; 21:1322-1330. [PMID: 30627378 PMCID: PMC6312675 DOI: 10.22038/ijbms.2018.25046.6213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 07/22/2018] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Broad range of metabolic changes associated with highly active antiretroviral therapy (HAART) has been reported over decades including reproductive perturbations. The current study aimed at investigating the role of Hypoxis hemerocallidea (Hyp) in the seminal and morphometric alterations in the testes of streptozotocin-nicotinamide-induced diabetic rats under HAART. MATERIALS AND METHODS Sixty-two adult male Sprague-Dawley rats were divided into A-H groups, containing 6 rats in the control group A and 8 rats in the treatment groups B-H. Diabetes was induced by intraperitoneal injection of nicotinamide (110 mg/kg BW) followed by streptozotocin (45 mg/kg BW). The animals were then subjected to various treatments with HAART, Hyp, and melatonin. RESULTS weights (body and testicular), histological, histochemical, seminal fluid, and morphometric analyses were carried out. Sperm count and motility were reduced in HAART (P<0.05/0.003) and Hyp200 (P<.003) groups compared with normal and diabetic controls, respectively. Sperm count was higher (P<.003) in HAART+ Mel and HAART+Hyp100 groups. Morphometry showed the reduction in germinal epithelium height and basement membrane thickness (P<.003) in the Hyp100 group compared with diabetic controls. Adjuvant use of Hyp and melatonin with HAART did not significantly raise these indices (P>.05). Histological slides showed gross distortions in HAART, diabetic and HAART +Hyp groups with marked atrophy in tubules, germ cell loss and areas of focal depletion of the cell. PAS staining revealed detached basement membrane in diabetic groups with strong PAS-stain. CONCLUSION The use of Hyp or melatonin does not ameliorate the testicular damages in diabetic animals under antiretroviral therapy.
Collapse
Affiliation(s)
- Ismail Onanuga Olasile
- Discipline of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences. Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa
- Department of Anatomy, Faculty of Medicine and Pharmaceutical Sciences, Kampala International University, Tanzania
| | - I Ayoola Jegede
- Discipline of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences. Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa
- Department of Anatomy, School of Medicine, The Copperbelt University, Kitwe, Zambia
| | - Offor Ugochukwu
- Discipline of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences. Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa
| | - O Oluwatosin Ogedengbe
- Discipline of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences. Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa
| | - Edwin CS Naidu
- Discipline of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences. Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa
| | - I Aniekan Peter
- Discipline of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences. Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa
| | - Onyemaechi O Azu
- Discipline of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences. Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa
- Department of Anatomy, School of Medicine, University of Namibia, Windhoek, Namibia
| |
Collapse
|
8
|
Abstract
PURPOSE OF REVIEW This review seeks to address the epidemiology and pathophysiological basis of the interaction between HIV infection and diabetes and the implication for treatment. Its importance stems from the current context of the growing burden of both conditions and the possible mechanisms of interactions that may exist but not yet sufficiently examined. RECENT FINDINGS HIV infection is associated with increased risk of insulin resistance, and ART is associated with metabolic derangement and the occurrence of type 2 diabetes. The increasing survival among people with HIV infection in developing countries is paralleled by a growing burden of chronic non-communicable diseases (NCDs) especially cardiovascular diseases and diabetes mellitus. The prevalence of diabetes mellitus is higher in HIV-positive persons compared to the general population, and especially those with associated hepatitis C virus (HCV) co-infection. Antiretroviral therapy (ART) during chronic HIV infection is the most incriminated risk factor for the development of diabetes mellitus through diverse mechanisms depending on the ART leading to insulin resistance and increased inflammatory status. A staggering 629 million of people 20-79 years are projected to have diabetes by 2045 while the world will soon enter the fourth decade of the HIV infection. Classical risk factors for diabetes such as physical inactivity and unhealthy diet may not solely explain the current trends, suggesting the role of novel risk factors including infections/inflammation. HIV and its treatment have been identified as potential contributors. Co-infections frequently observed during HIV infection also significantly influence both the epidemiological and pathophysiological of the link between HIV and diabetes. Although the relative contribution of each risk factor has not yet been quantified, several lines of evidence suggest that ART is a major contributor to hyperglycemia in HIV infection. ARTs have also led to an increase in metabolic dysfunction, including insulin resistance syndromes, dyslipidemia, and lipodystrophy. The association between ARTs and the risk of developing diabetes therefore calls for a careful choice of medication and evaluation of the risk of developing diabetes.
Collapse
Affiliation(s)
- Emile Camille Noubissi
- Department of Biochemistry, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Jean-Claude Katte
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Eugene Sobngwi
- National Obesity Center and Endocrine and Metabolic Diseases Unit, Yaoundé Central Hospital, Yaoundé, Cameroon.
- Department of Internal Medicine and Specialities, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon.
| |
Collapse
|
9
|
Lima MAC, Cunha GHD, Galvão MTG, Rocha RP, Franco KB, Fontenele MSM. Systemic Arterial Hypertension in people living with HIV/AIDS: integrative review. Rev Bras Enferm 2018; 70:1309-1317. [PMID: 29160495 DOI: 10.1590/0034-7167-2016-0416] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 01/04/2017] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To analyze scientific productions about the relationship between HIV and Systemic Arterial Hypertension (SAH) in people living with HIV/AIDS (PLWHA). METHOD Integrative literature review in six databases, held in March 2016. "AIDS" and "hypertension" were the keywords used in Portuguese, English and Spanish languages. We found 248 articles and selected 17. The categories formulated were "prevalence of SAH in PLWHA," "risk factors for SAH in PLWHA" and "adverse events of antiretroviral therapy (ART) that contribute to HAS." RESULTS There is no consensus whether HIV and ART influence the SAH development, but there are several risk factors for SAH among PLWHA. It was observed that protease inhibitors medicines influence SAH the most. CONCLUSION Guidelines for SAH prevention must be performed in all individuals, however, in PLWHA, they must focus on characteristic risk factors of this population.
Collapse
Affiliation(s)
- Maria Amanda Correia Lima
- Universidade Federal do Ceará, Department of Nursing, Health Care Research Group on HIV/AIDS and Chronic Conditions. Fortaleza, Ceará, Brazil
| | - Gilmara Holanda da Cunha
- Universidade Federal do Ceará, Department of Nursing, Health Care Research Group on HIV/AIDS and Chronic Conditions. Fortaleza, Ceará, Brazil.,Universidade Federal do Ceará, Department of Nursing, Research Group and Center of Studies on HIV/AIDS and Associated Diseases. Fortaleza, Ceará, Brazil
| | - Marli Teresinha Gimeniz Galvão
- Universidade Federal do Ceará, Department of Nursing, Research Group and Center of Studies on HIV/AIDS and Associated Diseases. Fortaleza, Ceará, Brazil
| | - Ryvanne Paulino Rocha
- Universidade Federal do Ceará, Department of Nursing, Health Care Research Group on HIV/AIDS and Chronic Conditions. Fortaleza, Ceará, Brazil
| | - Kátia Barbosa Franco
- Universidade Federal do Ceará, Department of Nursing, Health Care Research Group on HIV/AIDS and Chronic Conditions. Fortaleza, Ceará, Brazil
| | - Marina Soares Monteiro Fontenele
- Universidade Federal do Ceará, Department of Nursing, Health Care Research Group on HIV/AIDS and Chronic Conditions. Fortaleza, Ceará, Brazil
| |
Collapse
|
10
|
Nduka CU, Stranges S, Kimani PK, Sarki AM, Uthman OA. Is there sufficient evidence for a causal association between antiretroviral therapy and diabetes in HIV-infected patients? A meta-analysis. Diabetes Metab Res Rev 2017; 33. [PMID: 28437854 DOI: 10.1002/dmrr.2902] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 02/03/2017] [Accepted: 03/28/2017] [Indexed: 01/22/2023]
Abstract
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.
Collapse
Affiliation(s)
- Chidozie U Nduka
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Saverio Stranges
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, Ontario, Canada
- Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Peter K Kimani
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Ahmed M Sarki
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Olalekan A Uthman
- Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Warwick Medical School, University of Warwick, Coventry, UK
- Department of Public Health (IHCAR), Karolinska Institutet, Stockholm, Sweden
- Centre for Evidence-Based Health Care, Stellenbosch University, Tygerberg, South Africa
| |
Collapse
|
11
|
Prasad S, Sajja RK, Kaisar MA, Cucullo L. Hyperglycemia exacerbates antiretroviral drug combination induced blood-brain barrier endothelial toxicity. Neurotoxicology 2016; 56:1-6. [PMID: 27345270 DOI: 10.1016/j.neuro.2016.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 06/09/2016] [Accepted: 06/22/2016] [Indexed: 12/24/2022]
Abstract
In this study, we sought to investigate how concomitant hyperglycemia influences the impact of combination antiretroviral therapy on blood-brain barrier (BBB) endothelial function. Immortalized human brain microvascular endothelial cell line (hCMEC/D3) was exposed to azidothymidine (AZT; a nucleoside reverse transcriptase inhibitor) and/or indinavir (IND; protease inhibitor) in normal glycemic (5.5mM) or hyperglycemic (HG; 25mM) media containing D-glucose for 24-72h. Cellular reactive oxygen species (ROS) and mitochondria-specific superoxide levels were assayed in addition to membrane potential to determine the extent of mitochondrial dysfunction. Nrf2 expression was analyzed by immunofluorescence. Our results indicated a significant increase in BBB endothelial toxicity (decreased ATP) by HG and AZT+IND with progression of time (24-72h). Concurrent HG and antiviral drug combination synergistically elevated BBB endothelial ROS induced by either condition alone. Further, HG and AZT+IND mutually interact to elicit a pronounced increase in mitochondrial superoxide levels post 24h (vs. either condition alone or controls). In addition, HG and AZT+IND complemented each other to induce potential loss of mitochondrial membrane potential. While HG or AZT+IND alone for 24h increased Nrf2 nuclear distribution, co-exposure conditions induced a potential loss of Nrf2 expression/nuclear translocation in BBB endothelium. In summary, our data strongly suggest that antiretroviral drug combination potentially interacts with concomitant HG and triggers exacerbated mitochondrial dysfunction and BBB endothelial toxicity, possibly through dysregulation of Nrf2 signaling. Thus, this study warrants the critical need for safety evaluation and monitoring of neurovascular complications of HAART regimens in HIV-infected diabetic patient cohort.
Collapse
Affiliation(s)
- Shikha Prasad
- Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, 1300 S. Coulter Street, Amarillo, TX 79106, USA
| | - Ravi K Sajja
- Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, 1300 S. Coulter Street, Amarillo, TX 79106, USA
| | - Mohammad A Kaisar
- Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, 1300 S. Coulter Street, Amarillo, TX 79106, USA
| | - Luca Cucullo
- Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, 1300 S. Coulter Street, Amarillo, TX 79106, USA.
| |
Collapse
|
12
|
McIlleron H, Abdel-Rahman S, Dave JA, Blockman M, Owen A. Special populations and pharmacogenetic issues in tuberculosis drug development and clinical research. J Infect Dis 2015; 211 Suppl 3:S115-25. [PMID: 26009615 PMCID: PMC4551115 DOI: 10.1093/infdis/jiu600] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Special populations, including children and pregnant women, have been neglected in tuberculosis drug development. Patients in developing countries are inadequately represented in pharmacology research, and postmarketing pharmacovigilance activities tend to be rudimentary in these settings. There is an ethical imperative to generate evidence at an early stage to support optimal treatment in these populations and in populations with common comorbid conditions, such as diabetes and human immunodeficiency virus (HIV) infection. This article highlights the research needed to support equitable access to new antituberculosis regimens. Efficient and opportunistic pharmacokinetic study designs, typically using sparse sampling and population analysis methods, can facilitate optimal dose selection for children and pregnant women. Formulations suitable for children should be developed early and used in pharmacokinetic studies to guide dose selection. Drug-drug interactions between commonly coprescribed medications also need to be evaluated, and when these are significant, alternative approaches should be sought. A potent rifamycin-sparing regimen could revolutionize the treatment of adults and children requiring a protease inhibitor as part of antiretroviral treatment regimens for HIV infection. A sufficiently wide formulary of drugs should be developed for those with contraindications to the standard approaches. Because genetic variations may influence an individual's response to tuberculosis treatment, depending on the population being treated, it is important that samples be collected and stored for pharmacogenetic study in future clinical trials.
Collapse
Affiliation(s)
| | - Susan Abdel-Rahman
- Division of Clinical Pharmacology, Children's Mercy Hospital
- Department of Pediatrics, School of Medicine, University of Missouri–Kansas City,Missouri
| | - Joel Alex Dave
- Division of Diabetic Medicine and Endocrinology, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, South Africa
| | | | - Andrew Owen
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, United Kingdom
| |
Collapse
|
13
|
Prevalence of diabetes in Zimbabwe: a systematic review with meta-analysis. Int J Public Health 2014; 60:1-11. [PMID: 25432797 DOI: 10.1007/s00038-014-0626-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 10/31/2014] [Accepted: 11/17/2014] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Diabetes appears to be a growing problem in the African region. This study aims to estimate the prevalence of diabetes in Zimbabwe by collating and analyzing previously published data. METHODS Systematic review and meta-analysis of data reporting prevalence of diabetes in Zimbabwe was conducted based on the random effects model. We searched for studies published between January 1960 and December 2013 using MEDLINE, EMBASE and Scopus and University of Zimbabwe electronic publication libraries. In the meta-analysis, sub-groups were created for studies conducted before 1980 and after 1980, to understand the potential effect of independence on prevalence. RESULTS Seven studies were included in the meta-analysis with a total of 29,514 study participants. The overall pooled prevalence of diabetes before 1980 was 0.44% (95% CI 0.0-1.9%), after 1980 the pooled prevalence was 5.7% (95% CI 3.3-8.6%). CONCLUSIONS This study showed that the prevalence of diabetes in Zimbabwe has increased significantly over the past three decades. This poses serious challenges to the provision of care and prevention of disabling co-morbidities in an already disadvantaged healthcare setting.
Collapse
|
14
|
Onyeka TC, Velijanashvili M, Abdissa SG, Manase FA, Kordzaia D. Twenty-first century palliative care: a tale of four nations. Eur J Cancer Care (Engl) 2013; 22:597-604. [PMID: 23647421 DOI: 10.1111/ecc.12064] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2013] [Indexed: 02/05/2023]
Abstract
Hospice and palliative care development, in terms of availability and services, occur to varying degrees in the developing world. In this paper, the evolution of palliative care practices in four developing nations (Nigeria, Georgia, Ethiopia and Tanzania) is described. By highlighting common problems as well as the unique individual perspectives of each country's practice, this paper aims at increasing global awareness of palliative care in the developing world. While the call for palliative care to become a fundamental human right is sustained, it is also hoped that this article will stimulate a global discussion on the best possible way to encourage the establishment and growth of palliative care services in other developing countries where hitherto it has not been in existence, with policymakers and healthcare professionals taking the lead through the institution of sound national policies to promote and provide palliative care to all citizenry.
Collapse
Affiliation(s)
- T C Onyeka
- Pain & Palliative Care Unit, Multidisciplinary Oncology Centre, University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria.
| | | | | | | | | |
Collapse
|
15
|
Effect of nonnucleoside reverse transcriptase inhibitor-based antiretroviral therapy on dysglycemia and insulin sensitivity in South African HIV-infected patients. J Acquir Immune Defic Syndr 2011; 57:284-9. [PMID: 21602696 DOI: 10.1097/qai.0b013e318221863f] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Data on the prevalence of the complications of antiretroviral therapy (ART) (diabetes, central fat accumulation, peripheral fat wasting, and dyslipidemia) in sub-Saharan Africa are sparse. We examined the prevalence and associated risk factors of dysglycemia and insulin sensitivity in HIV-infected South Africans. METHODS HIV-infected patients, on nonnucleoside reverse transcriptase inhibitor-based ART or ART-naive, had oral glucose tolerance tests and clinical anthropometry. Insulin sensitivity and β-cell function were assessed. RESULTS The prevalence of dysglycemia in 406 ART-naive patients and 443 patients on ART was 25.7% and 21.9% (P = 0.193), respectively. Dysglycemic patients on ART had a similar body mass index (P = 0.440), greater waist circumference (P = 0.047), and smaller calf skinfold thickness (P = 0.015) than dysglycemic ART-naive patients but no difference in β-cell function or insulin sensitivity. Normoglycemic patients on ART had a greater body mass index (P = 0.0009), waist circumference (P = 0.0001), and abdominal skinfold thickness (P = 0.040), similar calf skinfold thickness (P = 0.079), and reduced β-cell function [lower insulinogenic index (P = 0.027) and oral disposition index (D(o), P = 0.020)] compared with normoglycemic ART-naive patients. In multivariate analysis, older age [odds ratio (OR): 1.04, 95% confidence interval (CI): 1.02 to 1.06], male gender (OR: 1.96, 95% CI: 1.28 to 2.99), higher CD4 count (OR: 1.0, 95% CI: 1.00 to 1.02) and use of efavirenz (OR: 1.70, 95% CI: 1.19 to 2.45) were associated with dysglycemia. CONCLUSIONS The prevalence of dysglycemia in ART-naive and ART patients was similar. Peripheral fat wasting was more common in dysglycemic patients on ART. The association of efavirenz with dysglycemia is important because first-line ART regimens in the developing world include nonnucleoside reverse transcriptase inhibitors, and increasingly, efavirenz is selected because of its perceived lower toxicity than nevirapine.
Collapse
|
16
|
Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital and B.R.I.D.E, Karnal, India
| | - Hamdy Sleim
- Department of Internal Medicine, Suez Canal University, Ismailia, Egypt
| | - Narendra Kotwal
- Department of Endocrinology, Armed Forces Medical College, Pune, Maharashtra, India
| |
Collapse
|
17
|
Kalra S, Unnikrishnan AG, Raza SA, Bantwal G, Baruah MP, Latt TS, Shrestha D, John M, Katulanda P, Somasundaram N, Sahay R, Pathan F. South Asian Consensus Guidelines for the rational management of diabetes in human immunodeficiency virus/acquired immunodeficiency syndrome. Indian J Endocrinol Metab 2011; 15:242-50. [PMID: 22028994 PMCID: PMC3193772 DOI: 10.4103/2230-8210.85573] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
As newer methods of management are made available, and accessible, survival rates with human immunodeficiency virus (HIV) are increasing. This means that chronic, metabolic complications of HIV are becoming more frequent in clinical practice, as acute morbidity is controlled. Management of HIV/acquired immunodeficiency syndrome (AIDS) is gradually expanding to include these chronic and metabolic complications of the disease, and the adverse effects associated with its treatments, including diabetes. Unfortunately, no guidelines are available to help the medical practitioners choose appropriate therapy for patients with these conditions. The aim of the South Asian Consensus Guidelines is to provide evidence-based recommendations to assist healthcare providers in the rational management of type 2 diabetes mellitus in patients with HIV. The development of these guidelines used systematic reviews of available evidence to form its key recommendations. These guidelines and associated review of literature represent a compilation of available knowledge regarding rational management of diabetes in HIV. Patients of diabetes with concomitant HIV infection are managed optimally with insulin therapy and judicious use of highly active antiretroviral therapy with suitable alternatives is also recommended. These guidelines should prove helpful to physicians, not only in South Asia, but also across the globe, while managing patients with coexistent HIV and diabetes.
Collapse
Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital and BRIDE, Karnal, India
| | | | - Syed Abbas Raza
- Department of Endocrinology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Ganpathy Bantwal
- Department of Endocrinology, St. Johns Medical College, Bangalore, India
| | | | - Tint Swe Latt
- Department of Endocrinology University of Medicine 2, Yangon, Myanmar
| | - Dina Shrestha
- Department of Endocrinology, Norvic International Hospital, Kathmandu, Nepal
| | - Mathew John
- Department of Endocrinology, Providence Endocrine and Diabetes Specialty Centre, Trivandrum, India
| | - Prasad Katulanda
- Department of Endocrinology, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | | | - Rakesh Sahay
- Department of Endocrinology, Osmania Medical College, Hyderabad, India
| | - Faruque Pathan
- Department of Endocrinology, BIRDEM Hospital, Dhaka, Bangladesh
| |
Collapse
|
18
|
Kalra S, Kalra B, Agrawal N, Unnikrishnan AG. Understanding diabetes in patients with HIV/AIDS. Diabetol Metab Syndr 2011; 3:2. [PMID: 21232158 PMCID: PMC3025836 DOI: 10.1186/1758-5996-3-2] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Accepted: 01/14/2011] [Indexed: 12/25/2022] Open
Abstract
This paper reviews the incidence, pathogenetic mechanisms and management strategies of diabetes mellitus in patients with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). It classifies patients based on the aetiopathogenetic mechanisms, and proposes rational methods of management of the condition, based on aetiopathogenesis and concomitant pharmacotherapy.
Collapse
Affiliation(s)
- Sanjay Kalra
- Dept of Endocrinology, Bharti Hospital, Karnal, India
| | - Bharti Kalra
- Dept of Endocrinology, Bharti Hospital, Karnal, India
| | | | | |
Collapse
|