New‐onset type 2 diabetes mellitus among patients receiving HIV care at Newlands Clinic, Harare, Zimbabwe: retrospective cohort analysis

Abstract

Objective To assess the incidence and associated factors of Type 2 Diabetes Mellitus (T2DM) among people living with HIV (PLHIV) in Zimbabwe. Methods We analyzed data of all HIV-infected patients older than 16 years who attended Newlands Clinic between March 1, 2004 and April 29, 2015. The clinic considers patients whose random blood sugar is higher than 11.1 mmol/L and which is confirmed by a fasting blood sugar higher than 7.0 mmol/L to have T2DM. T2DM is also diagnosed in symptomatic patients who have a RBS >11.0 mmol/l. Risk factors for developing T2DM were identified using Cox proportional hazard models adjusted for confounding. Missing baseline BMI data were multiply imputed. Results are presented as adjusted hazard ratios (aHR) with 95% confidence intervals (95%CI). Results Data for 4,110 participants were included: 67.2% were women; median age was 37 (IQR:31–43) years. Median baseline CD4 count was 197 (IQR: 95–337) cells/mm3. The proportion of participants with hypertension at baseline was 15.5% (n=638). Over a median follow-up time of 4.7 (IQR:2.1–7.2) years, 57 patients developed T2DM; the overall incidence rate was 2.8 (95%CI: 2.1 – 3.6) per 1000 person-years of follow up. Exposure to PIs was associated with T2DM (HR: 1.80, 95%CI: 1.04–3.09). In the multivariable analysis, obesity (BMI>30kg/m2) (aHR=2.26, 95%CI: 1.17–4.36), age >40yrs (aHR=2.16, 95%CI: 1.22–3.83) and male gender, (aHR=2.13, 95%CI: 1.22–3.72) were independently associated with the risk of T2DM. HIV related factors (baseline CD4 cell count and baseline WHO clinical stage) were not independent risk factors for developing T2DM. Conclusion Even though the incidence of T2DM in this HIV cohort was lower than has been observed in others, our results show that risk factors for developing T2DM among HIV-infected people are similar to those of the general population. HIV-infected patients in sub-Saharan Africa need a comprehensive approach to care that includes better health services for prevention, early detection and treatment of chronic diseases especially among the elderly and obese.

Virological failure among adolescents on ART, Harare City, 2017- a case-control study

“…In another study by Adrovandi et al, 2014, alcohol use was associated with poor adherence [21]. In contrast, Chimbetete et al, 2011 found no difference in treatment failure among those who were alcohol drinkers [8]. This could be explained by the levels of drinking alcohol in that study, which had no effect on their drug adherence levels.…”

“…This shows delay in ART initiation among adolescents. Chimbetete et al, 2011 also found that patients initiated on ART after developing AIDS related illness (WHO stage 3 & 4), and those who had low baseline CD4 counts had higher risk of treatment failure as compared to those in WHO stage 1 or 2 and those with high CD4 [8]. However the 2015 WHO guidelines expanded ART initiation to treat all.…”

“…Being on WHO stage 3 or 4 and having a low CD4 at ART initiation were also associated with virological failure [8]. Virological failure can be due to many factors like treatment interruption, resistant strains carried from mother to child transmission (MTCT), as well as exposure of the adolescent to resistant strain through the individual’s own infection due to unprotected sexual inter course [9].…”

Diabetes prevalence by HbA1c and oral glucose tolerance test among HIV-infected and uninfected Tanzanian adults

“…In our analysis, ageing, being male, and CD4 counts <200 cells/μL were significantly associated with diabetes by one or both tests. Ageing is well documented as a risk factor for diabetes, and male sex has been reported as a risk factor for diabetes among HIV-infected patients [40], although there is no clear explanation for this. In contrast to other studies showing increased diabetes risk with increased fat, especially central fat, we found virtually no associations of BMI, FMI, FFMI or waist circumference with diabetes risk.…”

It is aging and not antiretroviral therapy the strongest risk factor for chronic pain in HIV-positive population ?

“…this phenomenon is the increased prevalence and early onset of non-infectious co-morbitidies (particularly cardiovascular disease, chronic kidney disease, type 2 diabetes mellitus, and cancer) in HIV-positive individuals [3][4][5][6]. At the same time, we are observing accentuated aging in HIV-positive people, which is associated mainly with increased immune activation, impaired regulatory functions, as well as direct effects of HIV replication in tissues and organs.…”