Risk Factors for Incident Diabetes in a Cohort Taking First-Line Nonnucleoside Reverse Transcriptase Inhibitor-Based Antiretroviral Therapy

Karamchand, Sumanth; Leisegang, Rory; Schomaker, Michael; Maartens, Gary; Walters, Lourens; Hislop, Michael; Dave, Joel A.; Levitt, Naomi; Cohen, Karen

doi:10.1097/md.0000000000002844

Cited by 52 publications

(48 citation statements)

References 56 publications

(57 reference statements)

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“…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.…”

Section: Resultsmentioning

confidence: 99%

“…Most participants were on cART, except for participants in the Sagna et al 22 study who were on first-line therapy, which was not clearly specified. Mean age of participants ranged from 33.5 years 17 to 38 years 19 17 and was not stated in one of the studies. 20 Mean duration of follow-up ranged from 1.56 years 19 to 5.5 years, 17 and the total number of participants followed up to completion was n=56 875.…”

Section: Incidence Of T2dm In Hiv-infected Participantsmentioning

confidence: 99%

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

et al. 2017

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ObjectivesThis systematic review aims to investigate the incidence and prevalence of type 2 diabetes mellitus (T2DM) in patients with HIV infection in African populations.SettingOnly studies reporting data from Africa were included.ParticipantsA systematic search was conducted using four databases for articles referring to HIV infection and antiretroviral therapy, and T2DM in Africa. Articles were excluded if they reported data on children, animals or type 1 diabetes exclusively.Main outcome measuresIncidence of T2DM and prevalence of T2DM. Risk ratios were generated for pooled data using random effects models. Bias was assessed using an adapted Cochrane Collaboration bias assessment tool.ResultsOf 1056 references that were screened, only 20 were selected for inclusion. Seven reported the incidence of T2DM in patients with HIV infection, eight reported the prevalence of T2DM in HIV-infected versus uninfected individuals and five reported prevalence of T2DM in HIV-treated versus untreated patients. Incidence rates ranged from 4 to 59 per 1000 person years. Meta-analysis showed no significant differences between T2DM prevalence in HIV-infected individuals versus uninfected individuals (risk ratio (RR) =1.61, 95% CI 0.62 to 4.21, p=0.33), or between HIV-treated patients versus untreated patients (RR=1.38, 95% CI 0.66 to 2.87, p=0.39), and heterogeneity was high in both meta-analyses (I2=87% and 52%, respectively).ConclusionsMeta-analysis showed no association between T2DM prevalence and HIV infection or antiretroviral therapy; however, these results are limited by the high heterogeneity of the included studies and moderate-to-high risk of bias, as well as, the small number of studies included. There is a need for well-designed prospective longitudinal studies with larger population sizes to better assess incidence and prevalence of T2DM in African patients with HIV. Furthermore, screening for T2DM using gold standard methods in this population is necessary.Trial registration numberPROSPERO42016038689.

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Section: Resultsmentioning

confidence: 99%

Section: Incidence Of T2dm In Hiv-infected Participantsmentioning

confidence: 99%

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

et al. 2017

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“…59,60 This effect might be explained by mitochondrial toxicity associated with older anti-HIV drugs (zidovudine, stavudine, didanosine, and saquinavir) 61,62 that are still prescribed in some tropical countries, as well as newer drugs like efavirenz, as shown in a very large cohort in South Africa. 63 Additionally, in part due to the successful roll-out of HIV treatment in Africa, there are increasing numbers of older people at increased risk of developing diabetes. 64 Concurrent hepatitis C virus infection has also been linked with diabetes in HIV-infected patients, although data are conflicting, 61,62 and dialysis for end-stage renal disease in diabetes constitutes a risk for transmission of bloodborne viruses, including HIV, in tropical countries.…”

Section: Effect Of Diabetes Mellitus On Tuberculosis Hiv and Malariamentioning

confidence: 99%

The global diabetes epidemic: what does it mean for infectious diseases in tropical countries?

Crevel

Vijver

Moore

2017

The Lancet Diabetes & Endocrinology

135

109

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Tropical countries are experiencing a substantial rise in type 2 diabetes, which is often undiagnosed or poorly controlled. Since diabetes is a risk factor for many infectious diseases, this increase probably adds to the large infectious disease burden in tropical countries. We reviewed the literature to investigate the interface between diabetes and infections in tropical countries, including the WHO-defined neglected tropical diseases. Although solid data are sparse, patients with diabetes living in tropical countries most likely face increased risks of common and health-care-associated infections, as well as infected foot ulcers, which often lead to amputation. There is strong evidence that diabetes increases the severity of some endemic infections such as tuberculosis, melioidosis, and dengue virus infection. Some HIV and antiparasitic drugs might induce diabetes, whereas helminth infections appear to afford some protection against future diabetes. But there are no or very scarce data for most tropical infections and for possible biological mechanisms underlying associations with diabetes. The rise in diabetes and other non-communicable diseases puts a heavy toll on health systems in tropical countries. On the other hand, complications common to both diabetes and some tropical infections might provide an opportunity for shared services-for example, for eye health (trachoma and onchocerciasis), ulcer care (leprosy), or renal support (schistosomiasis). More research about the interaction of diabetes and infections in tropical countries is needed, and the infectious disease burden in these countries is another reason to step up global efforts to improve prevention and care for diabetes.

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“…As a consequence of the successful rollout of antiretroviral therapy (ART) in many African countries, a large number of women have access to ART and life expectancy has increased. ART, including the drugs in widespread use in the region, however, has been linked with T2DM risk,21 which may impact the prevalence of T2DM in women of childbearing age.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of type 2 diabetes mellitus in women of childbearing age in Africa during 2000–2016: protocol of a systematic review and meta-analysis

et al. 2016

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IntroductionAfrican women of childbearing age are increasingly being exposed to risk factors for type 2 diabetes mellitus (T2DM), most particularly obesity. A differentiating feature of diabetes in women of childbearing age is that the disease may affect the mother and the developing fetus. Apart from mapping the extent of the problem, understanding the prevalence of T2DM in African women of childbearing age can help to galvanise targeted interventions for reducing the burden of T2DM. This is a protocol for a systematic review aiming to assess the prevalence of and risk factors for T2DM in women of childbearing age (15–49 years) in Africa.Methods and analysesWe will carry out a comprehensive literature search among a number of databases, using appropriate adaptations of the African search filter to identify diabetes prevalence studies, published from 2000 to 2016, among African women of childbearing age (15–49 years) according to the WHO definition. Full copies of articles identified through searches and considered to meet the inclusion criteria will be obtained for data extraction and synthesis. The analysis of the primary outcome (prevalent diabetes) will include two steps: (1) identification of data sources and documenting estimates and (2) application of the random-effects meta-analysis model to aggregate prevalence estimates and account for between-study variability in calculating the overall pooled estimates and 95% CI for diabetes prevalence. We will assess heterogeneity and publication bias using established methods. This systematic review will be reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses Protocol (PRISMA-P) 2015.Ethics and disseminationEthical approval is not required for this study, given that this is a protocol for a systematic review, which utilises published data. The findings of this study will be widely disseminated through peer reviewed publications and conference presentations.Trial registration numberCRD42015027635.

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Risk Factors for Incident Diabetes in a Cohort Taking First-Line Nonnucleoside Reverse Transcriptase Inhibitor-Based Antiretroviral Therapy

Abstract: Supplemental Digital Content is available in the text

Cited by 52 publications

References 56 publications

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

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

The global diabetes epidemic: what does it mean for infectious diseases in tropical countries?

Prevalence of type 2 diabetes mellitus in women of childbearing age in Africa during 2000–2016: protocol of a systematic review and meta-analysis

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