The goal of the study is to generate data demonstrating that HIV patients have higher burden of diabetes in order to stimulate development of policies which will help optimize prevention and care of diabetes in HIV patients.
Access to antiretroviral therapy (ART) is increasing rapidly in low-income countries and HIV-infected patients initiate ART much earlier. As a result, these patients have prolonged life spans and, hence, longer HIV and ART exposure. Emerging data from high-income countries suggest HIV and ART may increase the risk of Diabetes Mellitus (DM). However, there is limited data on these links in SSA. The lack of these data prevents efforts to improve DM care in HIV programmes in SSA. We plan to study the link between HIV, ART and other risk factors on pre-DM and DM and associated complications and explore if these links are explained by inflammation, dyslipidemia, and excessive adiposity in HIV patients.
We propose to invite participants from two existing HIV cohorts recruited between 2006-2011, and recruit new smaller HIV cohort, all with a total of 640 HIV+, 1035 HIV-, and 670 HIV+ on ART participants to study these associations, and explore if such associations are explained by chronic inflammation, dyslipedemia, and ART-associated changes in body composition.
At baseline and end of one and two years, data on pre-DM and DM and risk factors and complications will be collected. Blood samples will be collected for glucose testing, assessment inflammatory markers and kidney functions. In addition, body composition will be measured using anthropometry and bioelectrical impedance analyser. Data collected at beginning of the two existing cohorts as well as in the two years follow-up will be used to address study objectives. Analysis will use regression models to control for multiple confounding.
Data generated on the links between HIV and ART and DM in SSA will be used by the Ministry of Health to optimize prevention, and clinical care of DM in HIV patients. To strengthen research capacity, the study will train 2 PhD and 1 MSc students, and provide laboratory equipments to NIMR laboratory to enhance DM and HIV research.
Preliminary results show that of those recruited, 59% (1,157) were females and the mean age was 41 years. The overall prevalence of diabetes was 13% by glycated haemoglobin A1c (HbA1c) test and 6% by oral glucose tolerance test (OGTT). However, prevalence differed by HIV status. Among HIV negative participants the prevalence was 9.3% by HbA1c and 4% by OGTT. Among HIV-infected ART naive patients the prevalence was 17.7% by HbA1c and 9.1% by OGTT whereas among ART-experienced patients the prevalence was 7.8% by HbA1c and 3.3% by OGTT. Independent risk factors for diabetes were HIV infection and CD4 count less than 200cells/μL while having adequate level of physical activity as recommended by the
World Health Organization decreased diabetes risk. These data have been submitted for publication.
These findings of high burden of diabetes among HIV-infected ART naive and HIV-infected ART-experienced patients suggest that health systems should consider integrating diabetes services, including screening, treatment and prevention in HIV clinics.