Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana.
Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
HIV Med. 2021 Apr;22(4):231-243. doi: 10.1111/hiv.13007. Epub 2020 Nov 10.
Available data from high-income countries suggest that people living with HIV (PLWH) have a four-fold higher risk of diabetes compared with HIV-negative people. In sub-Saharan Africa, with 80% of the global burden of HIV, there is a relative paucity of data on the burden and determinants of prevalent and incident dysglycaemia.
To assess the prevalence and incidence of pre-diabetes (pre-DM) and overt diabetes mellitus (DM) among PLWH in a Ghanaian tertiary medical centre.
We first performed a cross-sectional comparative analytical study involving PLWH on combination antiretroviral therapy (cART) (n = 258), PLWH not on cART (n = 244) and HIV-negative individuals (n = 242). Diabetes, pre-DM and normoglycaemia were defined as haemoglobin A1C (HBA1c) > 6.5%, in the range 5.7-6.4% and < 5.7% respectively. We then prospectively followed up the PLWH for 12 months to assess rates of new-onset DM, and composite of new-onset DM and pre-DM. Multivariate logistic regression models were fitted to identify factors associated with dysglycaemia among PLWH.
The frequencies of DM among PLWH on cART, PLWH not on cART and HIV-negative individuals were 7.4%, 6.6% and 7.4% (P = 0.91), respectively, while pre-DM prevalence rates were 13.2%, 27.9% and 27.3%, respectively (P < 0.0001). Prevalent DM was independently associated with increasing age [adjusted odds ratio (95% confidence interval) (aOR, 95% CI) = 1.82 (1.20-2.77) for each 10-year rise], male sex [aOR = 2.64 (1.20-5.80)] and log(triglyceride/HDL cholesterol) [aOR = 8.54 (2.53-28.83)]. Prevalent pre-DM was independently associated with being on cART [aOR (95% CI) = 0.35 (0.18-0.69)]. There were a total of 12 cases of incident DM over 359.25 person-years, giving 33.4/1000 person-years of follow-up (PYFU) (95% CI: 18.1-56.8/1000), and an rate of incident pre-DM of 212.7/1000 PYFU (95 CI: 164.5-270.9/1000). The two independent factors associated with new-onset DM were having pre-DM at enrolment [aOR = 6.27 (1.89-20.81)] and being established on cART at enrolment [aOR = 12.02 (1.48-97.70)].
Incidence rates of pre-DM and overt DM among Ghanaian PLWH on cART ranks among the highest in the literature. There is an urgent need for routine screening and a multidisciplinary approach to cardiovascular disease risk reduction among PLWH to reduce morbidity and mortality from the detrimental effects of dysglycaemia.
来自高收入国家的现有数据表明，与 HIV 阴性人群相比，HIV 感染者（PLWH）患糖尿病的风险高四倍。在撒哈拉以南非洲，全球 HIV 负担的 80%发生在该地区，关于糖尿病前期（pre-DM）和显性糖尿病（DM）的流行率和发病情况及其决定因素的数据相对较少。
评估加纳一家三级医疗中心接受联合抗逆转录病毒治疗（cART）的 PLWH 中 pre-DM 和显性 DM 的流行率和发病率。
我们首先进行了一项横断面比较分析研究，纳入了接受 cART 的 PLWH（n=258）、未接受 cART 的 PLWH（n=244）和 HIV 阴性个体（n=242）。糖尿病、pre-DM 和血糖正常分别定义为血红蛋白 A1C（HBA1c）>6.5%、5.7%至 6.4%和<5.7%。然后，我们前瞻性随访 PLWH 12 个月，以评估新发 DM 及新发 DM 和 pre-DM 的复合发生率。使用多变量逻辑回归模型来确定与 PLWH 血糖异常相关的因素。
接受 cART 的 PLWH、未接受 cART 的 PLWH 和 HIV 阴性个体的 DM 发生率分别为 7.4%、6.6%和 7.4%（P=0.91），pre-DM 患病率分别为 13.2%、27.9%和 27.3%（P<0.0001）。DM 的流行与年龄增长[调整后的优势比（95%置信区间）（aOR，95%CI）=1.82（1.20-2.77），每增加 10 岁]、男性[aOR=2.64（1.20-5.80）]和甘油三酯/高密度脂蛋白胆固醇比值[aOR=8.54（2.53-28.83）]独立相关。DM 的流行与接受 cART 独立相关[aOR（95%CI）=0.35（0.18-0.69）]。在 359.25 人年的随访中，共有 12 例发生新发 DM，随访 33.4/1000 人年（95%CI：18.1-56.8/1000），新发 pre-DM 的发生率为 212.7/1000 人年（95%CI：164.5-270.9/1000）。与新发 DM 相关的两个独立因素是基线时患有 pre-DM[aOR=6.27（1.89-20.81）]和基线时接受 cART[aOR=12.02（1.48-97.70）]。
加纳接受 cART 的 PLWH 中 pre-DM 和显性 DM 的发生率在文献中属于最高之列。迫切需要对 PLWH 进行常规筛查和采取多学科方法来降低心血管疾病风险，以降低血糖异常的有害影响导致的发病率和死亡率。
