title: Increased risk of dysglycaemia in South Africans with HIV; especially those on protease inhibitors.
abstract: OBJECTIVE
  To compare dysglycaemia prevalence (impaired fasting glucose (IFG), impaired glucose tolerance (IGT), or diabetes) in HIV-infected persons, stratified by antiretroviral therapy (ART), with a community-based survey (CBS) in Cape Town, South Africa.
  
  
  METHODS
  Three groups of HIV-infected adults without known diabetes were conveniently sampled from community healthcare centres; ART-naïve, first-line ART (non-nucleoside reverse transcriptase inhibitor (NNRTI) plus dual NRTIs), and second-line ART (lopinavir/ritonavir-boosted protease inhibitor plus dual NRTIs). The CBS recruited a representative cross-sectional sample from urban townships. Participants reporting ART use or known diabetes were excluded. All participants underwent oral glucose tolerance testing. Multiple logistic regression determined independent associations with dysglycaemia.
  
  
  RESULTS
  The samples comprised ART-naïve, first-line ART, second-line ART and CBS participants (n=393, 439, 108 and 880, respectively). Mean age was 34-40years. Dysglycaemia prevalence was as follows: CBS 18.0%, ART-naïve 21.6%, first-line ART 26.0% and second-line ART 37.0%. Diabetes was similar across groups, but IGT was 3-4-fold higher in second-line ART and CBS compared with ART-naïve and first-line ART groups. In contrast, IFG was 14.3-21.2% across HIV groups but only 1.5% in the CBS. Increased risk of dysglycaemia was associated with older age, female gender, and HIV status (ART-naïve: OR 2.31, 95% CI 1.65-3.24; first-line ART: OR 2.47, 95% CI 1.80-3.38; second-line ART: OR 4.10, 95% CI 2.54-6.61). Diabetes family history and central obesity were not related to dysglycaemia.
  
  
  CONCLUSIONS
  In view of the increased risk of dysglycaemia in HIV-infected participants, screening for diabetes should be instituted in ART programmes.
authors.affiliation: Division of Diabetic Medicine and Endocrinology, Department of Medicine, Faculty of Health Sciences, University of Cape Town (UCT), South Africa; Chronic Disease Initiative for Africa, Department of Medicine, Faculty of Health Sciences, UCT, South Africa. Electronic address: naomi.levitt@uct.ac.za.
authors.forename: Naomi S
authors.initials: NS
authors.lastname: Levitt
authors.affiliation: Non-communicable Diseases Research Unit, South African Medical Research Council (SAMRC), South Africa; Department of Medicine, Faculty of Health Sciences, UCT, South Africa.
authors.forename: Nasheeta
authors.initials: N
authors.lastname: Peer
authors.affiliation: Chronic Disease Initiative for Africa, Department of Medicine, Faculty of Health Sciences, UCT, South Africa.
authors.forename: Krisela
authors.initials: K
authors.lastname: Steyn
authors.affiliation: Biostatistics Unit, SAMRC, South Africa.
authors.forename: Carl
authors.initials: C
authors.lastname: Lombard
authors.affiliation: Division of Clinical Pharmacology, Department of Medicine, Faculty of Health Sciences, UCT, South Africa.
authors.forename: Gary
authors.initials: G
authors.lastname: Maartens
authors.affiliation: SAMRC/UCT Research Unit for Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, UCT, South Africa.
authors.forename: Estelle V
authors.initials: EV
authors.lastname: Lambert
authors.affiliation: Division of Diabetic Medicine and Endocrinology, Department of Medicine, Faculty of Health Sciences, University of Cape Town (UCT), South Africa.
authors.forename: Joel A
authors.initials: JA
authors.lastname: Dave
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001786:Blood Glucose / Q000032:analysis*; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D011480:Protease Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D012306:Risk; D013019:South Africa / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents; D001786:Blood Glucose; D011480:Protease Inhibitors
keywords: ART; Black; Diabetes; Dysglycaemia; HIV; South Africa