Relationship between combination antiretroviral therapy regimens and diabetes mellitus-related comorbidities among HIV patients in Gaborone Botswana

Abstract

BackgroundCombination antiretroviral therapy (cARTs) regiments are known to prolong the recipients’ life even though they are risk factors for diabetes mellitus-related comorbidities (DRCs). We sought to: (i) examine cART relationship with DRCs among patients attending HIV clinics in Gaborone, Botswana (which cART regimens are associated with shorter/longer time to the event), (ii) characterize patients’ underlying biomedical and demographic risk factors of DRC and identify the most important, (iii) investigate survival of patients on different cART regimens in the presence of these risk factors.MethodsData from two major HIV clinics in Botswana were reviewed. Relationships between different cART regimens and DRCs were investigated among 531 recipients. Recipients’ DRC risk factors were identified. Cox regression model was run. Unadjusted and adjusted hazard ratios were computed, and hazard and survival functions for different cART regimens were plotted.ResultsMajor findings were: patients on second- and third-line cART were less likely to develop DRCs earlier than those on first-line cART. Patients with CD4 count ≤ 200 cells/mm3 at cART initiation were more likely to develop DRCs earlier than those who had CD4 count > 200 cells/mm3. Overweight patients at cART initiation had a higher risk of developing DRCs earlier than those who had normal body mass index. Males had a lower risk of developing DRCs earlier than females.ConclusionThe risk of new onset of DRC among cART recipients is a function of the type of cART regimen, duration of exposure and patients’ underlying biomedical and demographic DRC risk factors. The study has provided a survival model highlighting DRCs’ significant prognostic factors to guide clinical care, policy and management of recipients of cARTs. Further studies in the same direction will likely improve the survival to the development of DRC of every cART recipient in this community.

Brain antioxidants and hippocampal microanatomical alterations following the administration of Efavirenz/Lamivudine/Tenofovir disoproxil fumarate and Lamivudine/Nevirapine/Zidovudine in adult male Wistar rats

“…Although HAART helped to improve the quality of life for PLWHA, it exposes patients to various diseases including neurological diseases, hyperglycemia, gastrointestinal, and lipodystrophy symptoms after longterm treatment ( Chowta et al, 2018 , Tshikuka et al, 2018 , Lawal et al, 2021 ). Long term exposure of the entire body to multiple drugs including HAARTs will lead to drug toxicity ( Naidu et al, 2021 ).…”

Silver Nanoparticles Conjugate Attenuates Highly Active Antiretroviral Therapy-Induced Hippocampal Nissl Substance and Cognitive Deficits in Diabetic Rats

“…While HAART has improved the quality of life of HIV patients [11], the longterm treatment predisposes patients on HAART to the development of other secondary derangements like neurological diseases, endocrine disorders (diabetes mellitus), and heart diseases [12,13]. The long-term effect of HAART is associated with chronic metabolic disorders like diabetes mellitus and dyslipidemia [14]. The metabolic disorders emerging from the combined antiretrovirals (cARVs) are associated with long-term exposure of the entire body to multiple drugs at high doses leading to drug toxicity [15].…”

Factors Associated with Treatment Outcomes among Patients Living with HIV and Hypertension Comorbidity in the Eastern Cape Province, South Africa

“…The development of antiretroviral drugs has significantly changed the perception of HIV/AIDS from a very fatal to a chronic and potentially manageable disease, and the availability and administration of antiretroviral therapy (ART) has significantly reduced mortality and morbidity associated with HIV and AIDS [12]. Whilst the combination antiretroviral therapy (cART) significantly increases patients' chances of surviving for a long period with HIV, it is also reported to increase risk of developing comorbidities [13]. This increased survival, however, also made PLWHIV more susceptible to developing NCDs like hypertension and other cardiovascular conditions [14].…”