Association between prior tuberculosis disease and dysglycemia within an HIV-endemic, rural South African population

Abstract

Objective Tuberculosis (TB) may predispose individuals to the development of diabetes. Such a relationship could have an outsized impact in high-prevalence TB settings. However, few studies have explored this relationship in populations heavily burdened by diabetes and TB. Methods We analyzed data from a community-based population cohort that enrolled adults in rural South Africa. Individuals were considered to have prior TB if they self-reported a history of TB treatment. We fitted sex-specific logistic regression models, adjusted for potential clinical and demographic confounders, to estimate relationships between dysglycemia (HBA1c ≥6.5%) and prior TB. Propensity score-matched cohorts accounted for the differential age distributions between comparator groups. We examined the interactions between sex, prior TB, and HIV status. Results In the analytic cohort (n = 17,593), the prevalence of prior TB was 13.8% among men and 10.7% among women. Dysglycemia was found in 9.1% of the population, and HIV prevalence was 34.0%. We found no difference in dysglycemia prevalence by prior TB (men OR 0.96, 95% CI 0.60–1.56: women OR 1.05, 95% CI 0.79–1.39). However, there was a qualitative interaction by HIV serostatus, such that among men without HIV, those with a history of TB had a greater prevalence of dysglycemia than those without prior TB (10.1% vs. 4.6%, p = 0.0077). An inverse relationship was observed among men living with HIV (prior TB 3.3% vs. no TB 7.3%, p = 0.0073). Conclusions Treated TB disease was not associated with dysglycemia in an HIV-endemic, rural South African population. However, we found a significant interaction between prior TB and HIV status among men, suggesting distinct pathophysiological mechanisms between the two infections that may impact glucose metabolism. Longitudinal studies are needed to better establish a causal effect and underlying mechanisms related to resolved TB, HIV, and diabetes.

Prior tuberculosis, radiographic lung abnormalities and prevalent diabetes in rural South Africa

“…This phenomenon may be akin to gestational diabetes, where women have resolution of glucose intolerance after delivery, but their risk for metabolic syndrome and insulin resistance later in life is nearly seven times greater than that of women without gestational diabetes [ 19 ]. Findings from our prior work in a rural South African population highlight a potential link between prior TB disease, HIV, and diabetes [ 20 ]. Specifically, HIV-negative men who completed TB treatment had a greater prevalence of diabetes than their TB-free counterparts [ 20 ].…”

“…Findings from our prior work in a rural South African population highlight a potential link between prior TB disease, HIV, and diabetes [ 20 ]. Specifically, HIV-negative men who completed TB treatment had a greater prevalence of diabetes than their TB-free counterparts [ 20 ].…”