Glucose Metabolism Disorders, HIV and Antiretroviral Therapy among Tanzanian Adults.
BACKGROUND
Millions of HIV-infected Africans are living longer due to long-term antiretroviral therapy (ART), yet little is known about glucose metabolism disorders in this group. We aimed to compare the prevalence of glucose metabolism disorders among HIV-infected adults on long-term ART to ART-naïve adults and HIV-negative controls, hypothesizing that the odds of glucose metabolism disorders would be 2-fold greater even after adjusting for possible confounders.


METHODS
In this cross-sectional study conducted between October 2012 and April 2013, consecutive adults (>18 years) attending an HIV clinic in Tanzania were enrolled in 3 groups: 153 HIV-negative controls, 151 HIV-infected, ART-naïve, and 150 HIV-infected on ART for ≥ 2 years. The primary outcome was the prevalence of glucose metabolism disorders as determined by oral glucose tolerance testing. We compared glucose metabolism disorder prevalence between each HIV group vs. the control group by Fisher's exact test and used multivariable logistic regression to determine factors associated with glucose metabolism disorders.


RESULTS
HIV-infected adults on ART had a higher prevalence of glucose metabolism disorders (49/150 (32.7%) vs.11/153 (7.2%), p<0.001) and frank diabetes mellitus (27/150 (18.0%) vs. 8/153 (5.2%), p = 0.001) than HIV-negative adults, which remained highly significant even after adjusting for age, gender, adiposity and socioeconomic status (OR = 5.72 (2.78-11.77), p<0.001). Glucose metabolism disorders were significantly associated with higher CD4+ T-cell counts. Awareness of diabetes mellitus was <25%.


CONCLUSIONS
HIV-infected adults on long-term ART had 5-fold greater odds of glucose metabolism disorders than HIV-negative controls but were rarely aware of their diagnosis. Intensive glucose metabolism disorder screening and education are needed in HIV clinics in sub-Saharan Africa. Further research should determine how glucose metabolism disorders might be related to immune reconstitution.
Department of Internal Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania.
Emmanuel
E
Maganga
Department of Internal Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania; Department of Internal Medicine, Bugando Medical Centre, Mwanza, Tanzania; Center for Global Health, Weill Cornell Medical College, New York, United States of America.
Luke R
LR
Smart
Department of Internal Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania; Department of Internal Medicine, Bugando Medical Centre, Mwanza, Tanzania.
Samuel
S
Kalluvya
Department of Internal Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania; Department of Internal Medicine, Bugando Medical Centre, Mwanza, Tanzania.
Johannes B
JB
Kataraihya
Weill Cornell Medical College in Qatar, Doha, Qatar.
Ahmed M
AM
Saleh
Weill Cornell Medical College in Qatar, Doha, Qatar.
Lama
L
Obeid
Department of Internal Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania; Department of Internal Medicine, Bugando Medical Centre, Mwanza, Tanzania; Center for Global Health, Weill Cornell Medical College, New York, United States of America.
Jennifer A
JA
Downs
Center for Global Health, Weill Cornell Medical College, New York, United States of America.
Daniel W
DW
Fitzgerald
Department of Internal Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania; Department of Internal Medicine, Bugando Medical Centre, Mwanza, Tanzania; Center for Global Health, Weill Cornell Medical College, New York, United States of America.
Robert N
RN
Peck
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D003430:Cross-Sectional Studies; D005260:Female; D044882:Glucose Metabolism Disorders / Q000150:complications* / Q000453:epidemiology / Q000276:immunology; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D013636:Tanzania / Q000453:epidemiology
D019380:Anti-HIV Agents