Prevalence and influences of diabetes and prediabetes among adults living with HIV in Africa
South Africa | Traditional cardiovascular risk factors, exposure to HIV per se and antiretroviral therapy (ART) are assumed to contribute to cardiometabolic diseases in people living with HIV (PLHIV). Controversy still exists on the relationship of HIV and ART with diabetes, and the extent to which these are modified by sociodemographic characteristics, body mass index (BMI), diagnostic definitions used for diabetes and prediabetes, and HIV-related characteristics including CD4 count, and the use and duration of ART. A new study conducted by researchers from the South African Medical Research Council (SAMRC), in conjunction with international collaborators, determined diabetes and prediabetes prevalence in PLHIV in Africa aiming to delineate these factors with the results being published in the Journal of the International AIDS Society (JIAS).
Significance of findings
The results of this systematic review and meta-analysis highlight that people living with HIV (PLHIV) in Africa have a high and established burden of prediabetes and diabetes, with prevalence rates of 15% for prediabetes and 5% for diabetes, with the latter approximating that observed in the general African population.
“This study is the first from Africa to synthesise the prevalence and influences of diabetes and prediabetes in PLHIV from a large number of studies”, explains Prof Nasheeta Peer, Chief Specialist Scientist at the SAMRC’s Non-Communicable Diseases Research Unit. “Our findings suggests that diabetes prevalence rates in PLHIV in Africa are similar to that of general populations on the continent and are influenced by similar risk factors”.
These conclusions were drawn from 61 studies examined. The pooled analyses were conducted among 86,412 and 7,976 participants for diabetes and prediabetes, respectively. The general trends suggested that traditional diabetes risk factors such as older age, greater body mass index which is an indicator of overweight and obesity, and urbanisation likely contributed to diabetes. HIV-related factors such as CD4 count, and the use and duration of antiretroviral therapy were not related to diabetes and prediabetes.
Furthermore, a substantial proportion of PLHIV with co-morbid diabetes in Africa were undiagnosed for their diabetes despite being in regular contact with healthcare services for their HIV. This underscores the disparities in management with free treatment provided for HIV but a minimal focus on diabetes in PLHIV on the continent.
There is thus an urgent need to integrate cost-effective and efficient screening, prevention and treatment of diabetes with HIV care to maintain the momentum and secure the advances made in optimising HIV management. Prof Liesl Zuhlke, Vice President of the SAMRC, adds that “In the South African public healthcare sector, there is growing awareness of the increasing burden of non-communicable disease comorbidities in PLHIV. Consequently, novel approaches such as hypertension text messaging interventions are being researched and implemented to treat PLHIV efficiently, cost-effectively and holistically with comorbidities”. This is important particularly in view of the high prevalence of prediabetes, which is a strong determinant of future diabetes. With about one in six PLHIV in Africa having prediabetes, this foretells a likely increase in future diabetes in PLHIV on the continent.
“These findings have important implications for public health policymakers and in clinical practice, with a change in approach needed for the care of PLHIV with comorbidities”, concluded Prof Peer.
Read the full journal article.
For more enquiries:
- Prof Nasheeta Peer
Non-Communicable Diseases Research Unit
Email: nasheeta.peer@mrc.ac.za - Dr Ebrahim Samodien
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