Shankalala Perfect, Jacobs Choolwe, Bosomprah Samuel, Vinikoor Michael, Katayamoyo Patrick, Michelo Charles
School of Public Health, Department of Epidemiology and Biostatiscs, University of Zambia, P.O Box 5110, Lusaka, Zambia.
Centre for Infectious Diseases Research in Zambia, 5032 Great North Road, Lusaka, Zambia.
J Diabetes Metab Disord. 2017 Jul 17;16:29. doi: 10.1186/s40200-017-0310-x. eCollection 2017.
Africa has a high prevalence of both Human Immunodeficiency Virus and Non Communicable Diseases (NCDs) but in Zambia there are few data on co-morbid NCDs like Diabetes Mellitus (DM) among HIV-infected individuals. We aimed to identify risk factors for impaired fasting glucose or diabetes among HIV-infected Zambians on long-term Combined Antiretroviral Treatment (cART).
This was a cross sectional study of adult HIV patients in five health facilities of Copperbelt Province in Zambia. HIV/AIDS patients aged 18 years and above, enrolled in care at those health facilities and had been on cART for more than 2 years were included. All patients known to have Diabetes mellitus were excluded from the study. Participants underwent assessment of random blood sugar levels at enrolment and returned the following morning for fasting glucose measured by glucometers. The primary outcome was proportion with impaired fasting glucose or DM. Multivariable logistic regression was used to examine if demographics, time on ART, type of ART regimen, body mass index and baseline CD4 count were predictors of impaired fasting glucose.
Overall ( = 270) there were 186 females (69%) and 84 males (31%). The prevalence of impaired fasting blood sugar or diabetes after 8 h of fasting was 15% (95%CI: 11.1, 20.0). Ten percent (26/270) had impaired fasting glucose and 5 % (14/270) had diabetes. Impaired fasting glucose was higher in males than females [AOR = 3.26, (95% CI: 1.15-9.25; -value = 0.03)]; as well as among patients on second line treatment than those on first line [AOR = 3.87 (95% CI 1.16-12.9); -value = 0.03]. In contrast those with less likelihood of impaired fasting glucose included patients with a normal BMI (18.5-24.9) than overweight or obese patients [AOR = 0.09 (95% CI 0.03-0.31; -value < 0.001)]; and participants who had less than 4 diabetes symptoms than those with more than 4 diabetes symptoms [AOR = 0.04 (95% CI 0.02-0.12); -value < 0.001].
We have found high levels of impaired fasting glucose or diabetes among ART patients compared to what is reported in the general population suggesting missed care and support opportunities associated with metabolic imbalance management. There is thus a need to re-package HIV programming to include integration of diabetes screening as part of the overall care and support strategy.
非洲人类免疫缺陷病毒和非传染性疾病（NCDs）的患病率都很高，但在赞比亚，关于艾滋病毒感染者中糖尿病（DM）等合并症的非传染性疾病的数据很少。我们旨在确定长期接受联合抗逆转录病毒治疗（cART）的赞比亚艾滋病毒感染者中空腹血糖受损或糖尿病的危险因素。
这是一项对赞比亚铜带省五个卫生设施中的成年艾滋病毒患者进行的横断面研究。纳入了年龄在18岁及以上、在这些卫生设施登记接受治疗且已接受cART治疗超过2年的艾滋病毒/艾滋病患者。所有已知患有糖尿病的患者均被排除在研究之外。参与者在入组时接受随机血糖水平评估，并于次日早晨返回用血糖仪测量空腹血糖。主要结局是空腹血糖受损或糖尿病的比例。使用多变量逻辑回归来检查人口统计学、接受抗逆转录病毒治疗的时间、抗逆转录病毒治疗方案类型、体重指数和基线CD4计数是否为空腹血糖受损的预测因素。
总体（n = 270）有186名女性（69%）和84名男性（31%）。禁食8小时后空腹血糖受损或糖尿病的患病率为15%（95%CI：11.1，20.0）。10%（26/270）的人空腹血糖受损，5%（14/270）的人患有糖尿病。男性空腹血糖受损高于女性[AOR = 3.26，（95%CI：1.15 - 9.25；P值 = 0.03）]；二线治疗患者比一线治疗患者的空腹血糖受损率也更高[AOR = 3.87（95%CI 1.16 - 12.9）；P值 = 0.03]。相比之下，空腹血糖受损可能性较小的包括体重指数正常（18.5 - 24.9）的患者，而非超重或肥胖患者[AOR = 0.09（95%CI 0.03 - 0.31；P值 < 0.001）]；以及糖尿病症状少于4种的参与者，而非多于4种糖尿病症状的参与者[AOR = 0.04（95%CI 0.02 - 0.12）；P值 < 0.001]。
我们发现与普通人群报告的情况相比，接受抗逆转录病毒治疗的患者中空腹血糖受损或糖尿病的水平较高，这表明在代谢失衡管理方面存在错过护理和支持的机会。因此，有必要重新规划艾滋病毒项目，将糖尿病筛查纳入作为整体护理和支持策略的一部分。
