Prioreschi A, Munthali R J, Soepnel L, Goldstein J A, Micklesfield L K, Aronoff D M, Norris S A
MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
BMJ Open. 2017 Mar 29;7(3):e013953. doi: 10.1136/bmjopen-2016-013953.
This systematic review aims to investigate the incidence and prevalence of type 2 diabetes mellitus (T2DM) in patients with HIV infection in African populations.
Only studies reporting data from Africa were included.
A systematic search was conducted using four databases for articles referring to HIV infection and antiretroviral therapy, and T2DM in Africa. Articles were excluded if they reported data on children, animals or type 1 diabetes exclusively.
Incidence of T2DM and prevalence of T2DM. Risk ratios were generated for pooled data using random effects models. Bias was assessed using an adapted Cochrane Collaboration bias assessment tool.
Of 1056 references that were screened, only 20 were selected for inclusion. Seven reported the incidence of T2DM in patients with HIV infection, eight reported the prevalence of T2DM in HIV-infected versus uninfected individuals and five reported prevalence of T2DM in HIV-treated versus untreated patients. Incidence rates ranged from 4 to 59 per 1000 person years. Meta-analysis showed no significant differences between T2DM prevalence in HIV-infected individuals versus uninfected individuals (risk ratio (RR) =1.61, 95% CI 0.62 to 4.21, p=0.33), or between HIV-treated patients versus untreated patients (RR=1.38, 95% CI 0.66 to 2.87, p=0.39), and heterogeneity was high in both meta-analyses (I=87% and 52%, respectively).
Meta-analysis showed no association between T2DM prevalence and HIV infection or antiretroviral therapy; however, these results are limited by the high heterogeneity of the included studies and moderate-to-high risk of bias, as well as, the small number of studies included. There is a need for well-designed prospective longitudinal studies with larger population sizes to better assess incidence and prevalence of T2DM in African patients with HIV. Furthermore, screening for T2DM using gold standard methods in this population is necessary.
PROSPERO42016038689.
本系统评价旨在调查非洲人群中感染人类免疫缺陷病毒（HIV）的患者2型糖尿病（T2DM）的发病率和患病率。
仅纳入报告来自非洲数据的研究。
使用四个数据库对涉及非洲HIV感染、抗逆转录病毒治疗和T2DM的文章进行系统检索。如果文章仅报告儿童、动物或1型糖尿病的数据，则将其排除。
T2DM的发病率和患病率。使用随机效应模型对汇总数据生成风险比。使用改编的Cochrane协作偏倚评估工具评估偏倚。
在筛选的1056篇参考文献中，仅20篇被选入。7篇报告了HIV感染患者中T2DM的发病率，8篇报告了HIV感染者与未感染者中T2DM的患病率，5篇报告了接受HIV治疗与未接受治疗患者中T2DM的患病率。发病率范围为每1000人年4至59例。荟萃分析显示，HIV感染者与未感染者中T2DM患病率之间无显著差异（风险比（RR）=1.61，95%置信区间0.62至4.21，p=0.33），接受HIV治疗患者与未接受治疗患者之间也无显著差异（RR=1.38，95%置信区间0.66至2.87，p=0.39），且两项荟萃分析中的异质性均较高（分别为I=87%和52%）。
荟萃分析显示T2DM患病率与HIV感染或抗逆转录病毒治疗之间无关联；然而，这些结果受到纳入研究的高度异质性、中到高偏倚风险以及纳入研究数量较少的限制。需要设计良好、样本量更大的前瞻性纵向研究，以更好地评估非洲HIV患者中T2DM的发病率和患病率。此外，有必要在该人群中使用金标准方法筛查T2DM。
PROSPERO42016038689。
