Abstract
Objective To review available literature on the prevalence, risk factors, pathophysiology, and clinical outcomes of dysglycemia among people living with HIV (PLHIV) in sub-Saharan Africa (SSA). Methods Database search on PUBMED for eligible studies describing the prevalence, risk factors, pathophysiology, or clinical outcomes of dysglycemia in SSA PLHIV. Results Prevalence of diabetes mellitus (DM) and pre-DM among SSA PLHIV ranged from 1% to 26% and 19% to 47%, respectively, in 15 identified studies. Older age and an elevated body mass index (BMI) were common risk factors for dysglycemia. Risk factors potentially more specific to PLHIV in SSA included exposure to older-generation thymidine analogues or protease inhibitors, malnutrition at ART initiation, a failure to gain fat mass on treatment, and elevated serum lipids. There is evidence of higher nephropathy and neuropathy rates among PLHIV in SSA with comorbid DM compared to HIV-negative individuals with DM. Conclusion There is a need for longitudinal studies to enhance understanding of the risk factors for dysglycemia among PLHIV in SSA, further research into optimal therapies to reduce pre-DM progression to DM among SSA PLHIV, and studies of the burden and phenotype of diabetic complications and other health outcomes among PLHIV with comorbid DM in SSA.
Highlights
Sub-Saharan Africa (SSA) accounts for 80% of the global HIV burden and 60% of new HIV infections [1]
Widescale adoption of combination antiretroviral therapy (ART) has decreased infection-related mortality among people living with HIV (PLHIV) and increased life expectancy, but this success is tempered by an increasing burden of noncommunicable diseases (NCDs) [2, 3]
Predominantly from US and European cohorts, indicates this elevated risk of dysglycemia, encompassing both diabetes mellitus (DM) and prediabetes (pre-DM; defined as impaired fasting glucose (IFG) or impaired glucose tolerance Journal of Diabetes Research (IGT)), in PLHIV likely reflects a mix of the effects of HIV per se, chronic inflammation, and some ART agents on glucose metabolism, as well as potentially disproportionate contributions of obesity and older age to DM risk among PLHIV compared to the general population [6, 7]
Summary
Sub-Saharan Africa (SSA) accounts for 80% of the global HIV burden and 60% of new HIV infections [1]. These include (i) higher levels of inflammation biomarkers such as high sensitivity C-reactive protein (hsCRP) and fibrinogen in HIVnegative SSA populations compared to HIC populations potentially reflecting a higher background inflammatory state [8], (ii) ongoing or recent use of older generation ART agents in SSA associated with the development of lipodystrophy and dysglycemia (e.g., thymidine analogues), (iii) limited access to DM screening, prevention, and treatment services in SSA [9], and (iv) a lower prevalence of traditional risk factors for DM such as advanced age, obesity, dyslipidemia, and sedentary lifestyles [10,11,12,13]
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