Nadir CD4+, religion, antiretroviral therapy, incidence of type 2 diabetes mellitus, and increasing rates of obesity among black Africans with HIV disease

Abstract

Background:The purpose of this study was to determine the cross-sectional association between some sociodemographic factors and antiretroviral therapy (ART), as well as the incidence and predictors of type 2 diabetes mellitus among Central Africans with human immunodeficiency virus (HIV) disease.Methods:This study had a cross-sectional design and was a prospective analysis of 102 patients with HIV disease (49 on ART versus 53 not on ART) in Kinshasa, Democratic Republic of Congo, between 2004 and 2008. A Cox regression model was used to assess for any relationship between type 2 diabetes and exposure to combination ART without protease inhibitors, after adjusting for known risk factors for type 2 diabetes, nadir CD4 and CD8 levels, viral load, marital status, and religion.Results:Unexpectedly elevated rates of smoking, excess alcohol intake, and ART-related total, abdominal, and peripheral obesity were observed in our study group of HIV patients. At the end of follow-up, five patients were diagnosed with type 2 diabetes (incidence rate 4.9%, 9.8 per 1000 person-years). Univariate risk factors for type 2 diabetes were male gender (relative risk [RR] 1.1, 95% confidence interval [CI] 1.01–1.4; P = 0.019), traditional religion versus new charismatic religion (RR 1.1, 95% CI 1.01–1.3; P = 0.046), exposure to ART (RR 1.1, 95% CI 1.002–1.3; P = 0.034), and single status (RR 6.2, 95% CI 1.5–15; P = 0.047). In multivariate analysis, strong significant independent predictors of type 2 diabetes were belonging to a traditional religion (HR 2.1, 95% CI 1.1–4.2; P = 0.036) and a relative increase in nadir CD4 cell count (beta coefficient 0.003; P < 0.0001).Conclusion:ART-related obesity and type 2 diabetes are becoming increasing problems in Central Africans with HIV disease. A relative increase in nadir CD4 count and traditional religion status appear to be the strongest independent predictors of type 2 diabetes.

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

“…After screening, 20 articles met the eligibility criteria [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] and were included in the analysis (figure 1). Of these, seven 17-23 articles reported incidence of T2DM in HIV-infected participants, eight 24-31 reported prevalence of T2DM in HIV-infected participants compared with uninfected controls and five 32-36 reported prevalence of T2DM in HIV-infected participants on treatment compared with untreated controls.…”

“…One of the included studies compared incidence in treated versus untreated participants, 21 and another compared incidence in infected versus uninfected participants. 20 The rest of the studies assessed incidence in HIV-infected and treated participants with no control group.…”

Incidence of Diabetes Mellitus and Obesity and the Overlap of Comorbidities in HIV+ Hispanics Initiating Antiretroviral Therapy

“…The incidence of insulin resistance that we found in our cohort is concerning, as impaired fasting glucose was observed in almost half of our cohort in a span of two years, despite the fact that very few patients (13%) were receiving protease inhibitors, which are traditionally associated with this phenomenon,[ 12 , 13 , 29 , 35 ] but not recommended for patients initiating ART in the DR. At the time of writing, a number of investigators have noted the rising prevalence of diabetes in LMIC,[ 16 , 17 ] but only two studies have examined the incidence of diabetes in LMICs outside of Latin America: one in the Democratic Republic of Congo reported DM incidence of 9.8/1000 PYFU, and one in Thailand reporting DM incidence of 5/1000 PYFU. [ 36 , 37 ] Other data from Latin America imply that the prevalence of diabetes and cardiovascular risk in people living with HIV is increasing; one cross-sectional study suggests high prevalence of DM in an aging population of HIV+ individuals, and an additional study in Brazil shows that the rate of increase in deaths attributable to CVD and DM is higher among HIV+ individuals compared to those without HIV. [ 16 , 17 ]…”

Maternal Stress and Pregnancy Outcomes

“…The kinds of stress factors were mostly related to emotional events such as unplanned or much desired pregnancy (after infertility or first pregnancy after age 35), preciousness due to previous loss (stillbirth), separation during pregnancy, tension in couple or in family, illness or death of relative and to past and present pregnancy risk factors (primi and multiparity, age < 18 years or ≥ 35 years, mother-infant's problems of previous pregnancies). Being married or cohabiting, coming from high socioeconomic level and belonging to a new charismatic religion more likely than that traditional religions (Catholic, Evangelical, Kimbanguist, and Islamic) to provide with social support [30] [31] were considered potential buffers, expected to be compensative. Socioeconomic status was defined on the basis of usual criteria in our setting [32]- [35].…”