Prevalence and incidence of pre‐diabetes and diabetes mellitus among people living with HIV in Ghana: Evidence from the EVERLAST Study

Norman, Betty; Nichols, Michelle; Appiah, Lambert; Assibey, Shadrack; Tagge, Raelle; Ovbiagele, Bruce

doi:10.1111/hiv.13007

Cited by 16 publications

(16 citation statements)

References 59 publications

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“…Our study showed overall prevalence of T2DM in 187 WLWH who received ARTs as 22 (11.8%), using FPG, 2hrs Postprandial OGTT glucose and HbA1c which was higher than the report by [18] in 2020 from Ghana who reported a prevalence of 7.4% [19]. The disagreement may be as a result of differences in age of study population.…”

Section: Resultscontrasting

confidence: 58%

Comorbidities and New Onset of Type 2 Diabetes Mellitus among Women Living with HIV Receiving Antiretroviral Therapy in Lagos, Nigeria

Enya

Enabulele

Ophori

et al. 2023

EJMED

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Background: There is limited gender stratified data in many type 2 diabetes mellitus (T2DM) studies in Africa. This study aimed to determine the prevalence of Comorbidities, New Onset of T2DM and risk factors influencing predisposition to T2DM among women living with HIV (WLWH) and receiving Antiretroviral Therapies. Methods: This was a cross-sectional study of females who were 15 years and above with HIV and/or without pulmonary TB attending HIV and TB DOTS clinics in Lagos, Nigeria from January 2019 to October 2021. The socio-demographic data of participants were obtained using questionnaire. Participants who were not known diabetic cases were tested for diabetes based on WHO and ADA standards using glycated haemoglobin (HbA1c) test, fasting plasma glucose and 2 hour 75 g oral glucose post prandial test. CD4 and CD8 counts were carried out using flow cytometer and their cytokines’ levels were determine using ELISA technique. HIV positive patients with signs and symptoms of TB (presumptive TB) were tested using sputum smear microscopy method and gene X-pert technique. We measured Body mass index (BMI) using International System of Units (kg/m2). Information on age, gender, Antiretroviral therapy (ART), values of CD4, weight, height, viral load and cholesterol test results less than 6 months were obtained from the patients’ folders. Results: A total of 187 WLWH were studied. Their mean age was 41.93±10.32 years. Fifty-five (27.9%) had BMI values of ≥ 30 kg/m2. Twenty-one (11.2%) had impaired glucose level. Those with T2DM at baseline were 5(2.7%), 17(9.1%) later developed T2DM. There was strong association between newly developed T2DM and obesity odd ratio (OR) 8.21(95% CI 1.30-51.99), interleukin (IL-): IL-6 OR 4.50 (95% CI 0.58-35.15), viral load with OR as 1.34(0.48-3.75), knowledge of diabetes OR 2.24 (95% CI 0.43-11.62), consumption of alcohol OR 2.03(95% CI 0.60-6.90). Twenty (10.7%) WLWH developed pulmonary TB while receiving ART. Co-morbidities recorded were: HIV/T2DM 14(7.5%), HIV/TB 21(11.2%), HIV/TB/T2DM 7(3.7%). A total of 42(22.7%) were on 2nd line ART. Conclusion: Prevalence of HIV/TB co-infection, HIV/T2DM comorbidity and HIV/TB/T2DM multimorbidity were high. Also the prevalence of incident TB and new cases of T2DM among the study population were high. There was positive association between development of T2DM while receiving ART and obesity, IL-6, knowledge of diabetes and alcohol consumption. Protease inhibitors were found to influence the development of T2DM among WLWH while receiving ART. Recommendation: There is need for promoting awareness of T2DM and its risk factors among WLWH who are receiving ART.

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Section: Resultscontrasting

confidence: 58%

Comorbidities and New Onset of Type 2 Diabetes Mellitus among Women Living with HIV Receiving Antiretroviral Therapy in Lagos, Nigeria

Enya

Enabulele

Ophori

et al. 2023

EJMED

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“…The need for a greater focus towards prevention and early detection of CKD in low-and middle-income countries has been emphasized in global health literature 47,48 , in part because treatment for ESRD is highly specialized 49 and costly for healthcare systems already challenged with scarcer resources than HICs. This is particularly important since other comorbidities contributing to CKD are increasingly seen in this population 50,51 .…”

Section: Discussionmentioning

confidence: 99%

Predictors of long-term progression to chronic kidney disease in HIV infection in Ghana from 2003-2018

Chadwick

Barker

Smith

et al. 2022

Preprint

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AimHIV is associated with an increased risk of progression to chronic kidney disease (CKD), and this risk is higher in people of West African descent than many other ethnicities. Our study aimed to assess the rates of progression to CKD and predictors of rapid progression in patients receiving antiretroviral therapy (ART) in central Ghana between 2003 and 2018.MethodsThis single-centre retrospective study enrolled people with HIV (PWH) initiating ART in Ghana between 2003-2018. Demographics, hepatitis B (HBsAg) status, ART regimens and eGFR measurements were recorded, and multi-level model linear regression was performed to determine predictors of greater levels of eGFR decline.Results659 participants were included in the study with a median follow-up time of 6 years (IQR 3.6-8.9). 149 participants (22.6%) also had confirmed HBV co-infection. Tenofovir was associated with the highest mean rate of eGFR decline of all Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs), representing a statistically significant annual decline -1.08 mL/min/1.73m2/year (CI: -0.24, -1.92) faster than those taking zidovudine. Regarding other ARTs, both nevirapine (-0.78mL /min/173m2/year; CI: -0.17, -1.39) and protease inhibitors (-1.55mL/mil/173m2/year; CI: - 0.41, -2.68) were associated with slower eGFR declines compared with efavirenz. Negative HbsAg status was associated with greater eGFR decline compared with positive HBsAg status (-1.25mL/mil/173m2; CI 0.29. 2.20).ConclusionIncreased rates of eGFR decline amongst PWH in Ghana were associated with tenofovir, nevirapine, and protease inhibitor use as well as negative HBsAg status. Further higher-quality research is needed to explore long-term predictors of eGFR decline in African populations.

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“…Metabolic disorders such as diabetes mellitus (DM) have been associated with HIV and ARVs ( Echecopar-Sabogal et al, 2018 ; Sarfo et al, 2021 ), and carbohydrate metabolism abnormalities like insulin resistance, hyperglycemia, and DM have been associated with ARVs of the class protease inhibitors (PIs) ( Noor et al, 2006 ). Some earlier PIs such as indinavir and lopinavir/ritonavir exasperate lipid profiles and increase the risk of developing insulin resistance, hyperglycemia, and DM ( Overton et al, 2016 ).…”

Section: Introductionmentioning

confidence: 99%

HIV Protease Inhibitors and Insulin Sensitivity: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

et al. 2021

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Background: Protease inhibitors (PIs) are believed to affect insulin sensitivity. We aimed to analyze the effect of PIs on insulin sensitivity and the onset of diabetes mellitus (DM) in patients with HIV.Methodology: We searched PubMed, Google Scholar, ClinicalTrals.gov, and the WHO International Clinical Trials Registry Platform till November 2020 for randomized controlled trials (RCTs) that studied the effects of PIs on insulin sensitivity and DM in patients with HIV. We followed the PRISMA and PICOS frameworks to develop the search strategy. We used the random-effects meta-analysis model to estimate the mean difference (MD), standardized mean difference (SMD), and risk ratios for our outcomes, using Stata 14 software.Results: We included nine RCTs that enrolled 1,000 participants, with their ages ranging from 18 to 69 years. The parameters and investigations used in the studies to determine insulin sensitivity were glucose disposal rates, hyperglycemia, and mean glucose uptake. The majority of results showed an association between PIs and insulin sensitivity. The pooled analysis showed no statistically significant difference in insulin sensitivity with atazanavir, whether the study was performed on healthy individuals for a short term or long term in combination with other drugs like tenofovir or emtricitabine [SMD = 0.375, 95% CI (0.035, 0.714)]. The analysis showed reduced glucose disposal rates and hence reduced insulin sensitivity with lopinavir (heterogeneity chi-squared = 0.68, I-squared [variation in SMD attributable to heterogeneity] = 0.0%, p = 0.031). The heterogeneity with chi-squared was substantial (61–80%), while with I-squared was not significant (0–40%), p = 0.031). Less adverse events were observed with atazanavir than with lopinavir [RR = 0.987, 95% CI (0.849, 1.124)]. Darunavir and indinavir did not demonstrate any significant changes in insulin sensitivity. Most of the studies were found to have a low risk of bias.Conclusions: There are significant variations in the effects of PIs on insulin sensitivity and onsets of DM. Atazanavir, fosamprenavir, and darunavir did not demonstrate any significant changes in insulin sensitivity, compared to the rest of the group. There is a need to assess the benefits of PIs against the long-term risk of impaired insulin sensitivity. All patients newly diagnosed with HIV should have DM investigations before the start of ARVs and routinely. RCTs should focus on sub-Saharan Africa as the region is worst affected by HIV, but limited studies have been documented.

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Prevalence and incidence of pre‐diabetes and diabetes mellitus among people living with HIV in Ghana: Evidence from the EVERLAST Study

Cited by 16 publications

References 59 publications

Comorbidities and New Onset of Type 2 Diabetes Mellitus among Women Living with HIV Receiving Antiretroviral Therapy in Lagos, Nigeria

Comorbidities and New Onset of Type 2 Diabetes Mellitus among Women Living with HIV Receiving Antiretroviral Therapy in Lagos, Nigeria

Predictors of long-term progression to chronic kidney disease in HIV infection in Ghana from 2003-2018

HIV Protease Inhibitors and Insulin Sensitivity: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

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