Insulin Resistance and Glucose Intolerance in HIV Infected Children on Antiretroviral Therapy at Lubango Pediatric Hospital - Angola

Abstract

Introduction: Antiretroviral therapy (ART) has proved to be an important intervention in the reduction of both morbidity and mortality of HIV infected patients. As the use of ART increases, a number of studies have associate it to some metabolic complications including glucose intolerance, dyslipidaemia, and diabetes mellitus. Despite the high prevalence of HIV/AIDS in Africa and the recent increased access to Antiretroviral drugs, information on ART related insulin resistance and glucose metabolism in the African population including children is scarce if not almost non-existent posing a barrier to implementation of a monitoring plan in Angola. Objective: To describe the pattern of insulin resistance and glucose metabolism among HIV infected children on ART between 3-14 years of age at Lubango paediatric hospital. Methods: The study adopted a Cross-sectional study design and data were collected using an interviewer administered questionnaire, clinical examination and anthropometric measurements of HIV infected children on ART. Venous blood sample was obtained for fasting blood glucose and fasting insulin and HOMA-IR was calculated, followed by an Oral glucose tolerance test as per World Health Organization guidelines. Result: In this study, 40% (20) and 20% (10) of the children had an OGTT and calculated HOMA-IR of more than 7.8 mm/l and 1.999 respectively. In the bivariate analysis, children who had history of diabetes in the family were significantly more likely to have Insulin Resistance (p 0.027). Female sex (p 0.038), advanced clinical stage of the AIDS disease (p < 0.001) had a strong association with abnormal OGTT while long time on ARV were moderately associated with abnormal OGTT (p 0.057). Conclusion: There is a high prevalence of insulin resistance and glucose intolerance among HIV positive children on ART on follow up at Lubango paediatrics hospital. Insulin resistance was associated with family history of Diabetes white glucose intolerance was associated with female sex, advance stage of AIDS and long time on antiretroviral therapy.

High prevalence of impaired glucose metabolism among children and adolescents living with HIV in Ghana

“…Our study has demonstrated that CALWH in Ghana exhibit elevated HbA1c levels. We observed a prevalence of insulin resistance of 22% based on the HOMA index, which is slightly higher than in previous studies conducted among children in sub-Saharan Africa (20%) [35]. However, a much higher prevalence has been reported in European children (52%) and adults in sub-Saharan Africa (47%) [21,36].…”

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

“…The results of both analyses correlate with each other, showing no significant changes. In a cross-sectional study in Angola ( Francisco et al, 2020 ), insulin resistance based on the homeostatic model (HOMA-R) was 20% and glucose intolerance was 40%. Two other cross-sectional analyses of longitudinal cohort and cohort studies conducted in Italy ( Rosso et al, 2007 ) and Rwanda ( Dusingize et al, 2013 ) compared median HOMA IR and fasting glucose.…”

Human immunodeficiency virus and antiretroviral therapy-mediated immune cell metabolic dysregulation in children born to HIV-infected women: potential clinical implications

“…Insulin resistance, measured using the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), is also common among HIV-infected children on ART. A recent study observed insulin resistance in 20% of the HEI children with clinical end stage of the disease and long-time on ART ( 38 , 77 ) ( Table 1 ). Changes in glucose transport and metabolism contribute to impaired insulin secretion by beta cells and altered glycogen synthesis in hepatocytes which significantly increase the risk of developing type 2 diabetes among PLWHA on ART ( 78 ).…”