Abstract:

Background: Mortality and morbidity from human immunodeficiency Virus (HIV) infection and its complications have dramatically declined since the advent of combination antiretroviral therapies (ARTs). This has transformed the disease from an inexorably fatal illness to a chronic condition where infected individuals with access to the drugs can live a long healthy life. However, metabolic disorders such as diabetes mellitus (DM), lipid disorders and cardiovascular diseases have emerged as a growing concern in this population. With the increase in availability and accessibility of ARTs worldwide there has been an increasing prevalence of long-term side effects including HIV lipodystrophy, carbohydrate metabolism and lipid metabolism abnormalities among a patients. Several risk factors have been linked including increased age, sex, change in body mass index (BMI), low CD4 count, as well as the type and duration of ART the HIV patient is using, especially protease inhibitors (PIs) and nucleoside reverse transcriptase inhibitors (NRTIs). Little is known about the magnitude and predictors glucose metabolism disorders in Tanzania despite the reported increase in frequency in the west as well as in Africa.

Methodology: This was an analytical cross-sectional study, which was conducted at the Bugando Medical Centre (BMC) Care and Treatment Centre (CTC) among 461 participant: 153 HIV positive ART naïve patients, 153 HIV patients on ART for more than 2 years and 155 HIV negative controls. An oral glucose tolerance test (OGTT) and fasting blood glucose (FBG) were performed in each patient and compared with standard World Health Organization (WHO) clinical definition for impaired fasting blood glucose (IFBG) and DM.

Results: A total of 461 participants were serially enrolled into the study in the three groups as described above. In the HIV positive group on ART for >2 years the median age was 40 years [38-47] and 118 (77.1%) were female, in the HIV negative group, the median age was 37 years [32-44] and 91 (95%) were female; and in HIV positive ART naïve group the median age was 40 years [38-47] and 118 (77.1%) were female. Among patients on ART, 49(32%) had one or more forms of glucose metabolism disorders compared to 7.1% (11 participants), and 8.5% (13 participants) among HIV negative and ART naïve groups respectively. The prevalence of overt DM was also high among patient on ART 27 (17.7%) as compared to 5.2% (8 participants) and 0.7% ( 1 participants) among HIV-negative and ART naïve groups respectively. These were when both FBG and OGTT were done. Most of patients with GMD were captured by FBG test than OGTT. HIV status and central obesity were significantly associated with glucose metabolism disorders (2.44 [1.48 – 4.0], p<0.001) and (2.8 [1.22-6.79], p=0.016 respectively. Protease inhibitor use showed a trend toward being a positive predictor of the glucose metabolism disorders but was not statistically significant (2.21 [0.66-7.35]).

Conclusions: Participants who were on ART had high prevalence of glucose metabolic disorders compared to their counterparts (HIV-negatives and HIV positive ART naïve). The strongest predictor of DM in this population was abdominal obesity. The prevention of abdominal obesity would likely help to prevent GMDs.