Diabetes and metabolic complications among patients with HIV and AIDS

Abstract

HIV infection, as well as its treatment with highly active retroviral therapy (HAART), is associated with a number of metabolic abnormalities such as insulin resistance, glucose intolerance and dyslipidaemia. The aim of this descriptive cross sectional study was to describe the prevalence of diabetes, impaired fasting glucose, dyslipidaemia and obesity among patients with HIV or AIDS who were followed up at the National Sexually Transmitted Diseases (STD) campaign in the year 2010, and to assess the associated factors.A total of 268 patients were evaluated of which 57.8% were male. Fifty six percent were on HAART therapy. Eighteen patients (6.7%) were diabetics and forty nine (18.3%) had impaired fasting glucose. Only about 40% of the diabetic patients were followed up regularly. About 20% of the patients had high total cholesterol levels (>240mg/dl) and only 24.4% patients had an optimal LDL cholesterol level of <100 mg/dl. 15.3% of the patients had high serum triglyceride levels (200-499mg/dl) and 1.9% had very high triglyceride levels (>500 mg/dl). Fourteen percent of the patients were overweight and 18.2% of the patients were obese according to the WHO criteria for body mass index for Asians. Being on HAART therapy was significantly associated with having high total cholesterol levels, high LDL cholesterol levels and high triglyceride cholesterol levels but not with elevated blood glucose values in the X 2 test (p<0.05). The mean total cholesterol, LDL cholesterol and triglyceride levels were also significantly different among HAART users and non users. Having HIV for more than 3.1 years (more than the median) and duration of HAART therapy for more than 1.9 years (more than the median) were also significantly associated with high total cholesterol and LDL cholesterol levels (p<0.05).Metabolic abnormalities are common among HIV infected persons and some of them are associated with the duration of HIV and the use of HAART therapy.

Is there sufficient evidence for a causal association between antiretroviral therapy and diabetes in HIV‐infected patients? A meta‐analysis

“…From 602 records identified through electronic database searching, 19 records from cross‐references, and 28 417 records from the WHO International Clinical Trials Registry Platform, we excluded 560 abstracts and 11 duplicate records. Of 50 remaining full texts assessed for eligibility, 9 articles were withdrawn, leaving 41 studies that were deemed eligible for inclusion in the meta‐analyses . In total, there were 20 178 participants, with approximately twice as many ART‐exposed as there were ART‐naïve patients.…”

“…The average age of the total study population was 42 years, and women accounted for 40%. Most studies were conducted in low-and middle-income countries, including Brazil, 19,40,41,59 Cameroon, 39,42,51,57 Ethiopia, 20,30,54 Ghana, 56 India, 33,49,52,53,60 Nigeria, 32,38,55 South Africa, 17,31 Sri Lanka, 61 Thailand, 14 and Zambia. 46 However, the studies conducted in high-income countries were generally larger in size, comprising more than half of the total study population.…”