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.
First-year report 2016:
In brief, based on the approved protocol, the following is the summary of project
objectives, outputs and outcomes:
1.To assess the burden of diabetes and associated demographic and behavioural risk factors among HIV patients
2.To assess if HIV, ART, chronic immune activation, inflammation, dyslipidaemia and body composition changes increase the risk of diabetes and related complications in HIV patients
3. To build research capacity in diabetes and HIV
1.Scientific publications including theses
3.Course in diabetes management
5.Reports to funder
1.Change in policy in diabetes and HIV
2.Data available for meta-analyses
3.Improved management of diabetes in HIV patients
4.Better primary and secondary prevention of diabetes
5.More research on diabetes and HIV
6.Development of guidelines on management of diabetes in HIV
7.Teaching of diabetes management in HIV clinics.