Relationship between hyperglycemia and the risk of tuberculosis in Asian HIV-positive individuals in the antiretroviral therapy era: cohort study.

Abstract

Many low-middle income countries, including in Asia, are now facing the intersection of two epidemics-of communicable and non-communicable diseases, including diabetes mellitus (DM) and tuberculosis (TB) specifically.1 DM has been recognised as an important risk factor for TB in the general population, especially in the TB endemic settings.1,2 Poorly controlled diabetics (with HbA1C>7%) are the main group at a higher risk of TB.1 Finally, DM is also believed to elevate the risk of serious infections in general.3 Although the mechanisms of these associations are not clear, they are thought to be directly related to hyperglycemia and cellular insulinopenia, as well as indirect effects of hyperglycemia on macrophage and lymphocyte function.1,3 HIV-positive individuals are at high risk of TB.4 Further, diabetes has emerged as one of the important co-morbidities in HIV-positive individuals, especially in the antiretroviral therapy (ART) era.5,6 However, the relationship between blood glucose levels and TB in HIV positive population has been remarkably understudied.7,8 Investigating this relationship in HIV-positive individuals is important not only for better clinical management of HIV but also for TB control in general. In this study, we model the relationship between fasting blood glucose and risk of TB in the TREAT Asia HIV Observational Database (TAHOD), a multi-country Asian cohort of HIV-positive individuals.