Affiliation:
1. Non‐communicable Diseases Research Unit South African Medical Research Council Durban and Cape Town South Africa
2. Department of Medicine University of Cape Town Cape Town South Africa
3. Section on Ethnicity and Health Diabetes Endocrinology and Obesity Branch National Institute of Diabetes and Digestive and Kidney Diseases National Institute of Health Bethesda Maryland USA
4. National Institute on Minority Health and Health Disparities National Institutes of Health Bethesda Maryland USA
5. Faculty of Medicine Université Catholique de Bukavu Bukavu the Democratic Republic of the Congo
6. Division of Infectious Diseases Department of Medicine Stellenbosch University Faculty of Medicine and Health Sciences Cape Town South Africa
7. Department of Epidemiology Infectious Diseases and Microbiology and Center for Global Health University of Pittsburgh Pittsburgh Pennsylvania USA
8. Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
9. Department of International Health Bloomberg School of Public Health Johns Hopkins University Baltimore Maryland USA
Abstract
AbstractIntroductionIn people living with human immunodeficiency virus (PLHIV), traditional cardiovascular risk factors, exposure to HIV per se and antiretroviral therapy (ART) are assumed to contribute to cardiometabolic diseases. Nevertheless, controversy exists on the relationship of HIV and ART with diabetes. To clarify the relationship between HIV and type 2 diabetes, this review determined, in PLHIV in Africa, diabetes and prediabetes prevalence, and the extent to which their relationship was modified by socio‐demographic characteristics, body mass index (BMI), diagnostic definitions used for diabetes and prediabetes, and HIV‐related characteristics, including CD4 count, and use and duration of ART.MethodsFor this systematic review and meta‐analysis (PROSPERO registration CRD42021231547), a comprehensive search of major databases (PubMed‐MEDLINE, Scopus, Web of Science, Google Scholar and WHO Global Health Library) was conducted. Original research articles published between 2000 and 2021 in English and French were included, irrespective of study design, data collection techniques and diagnostic definitions used. Observational studies comprising at least 30 PLHIV and reporting on diabetes and/or prediabetes prevalence in Africa were included. Study‐specific estimates were pooled using random effects models to generate the overall prevalence for each diagnostic definition. Data analyses used R statistical software and “meta” package.ResultsOf the 2614 records initially screened, 366 full‐text articles were assessed for eligibility and 61 were selected. In the systematic review, all studies were cross‐sectional by design and clinic‐based, except for five population‐based studies. Across studies included in the meta‐analysis, the proportion of men was 16–84%. Mean/median age was 30–62 years. Among 86,412 and 7976 participants, diabetes and prediabetes prevalence rates were 5.1% (95% CI: 4.3–5.9) and 15.1% (9.7–21.5). Self‐reported diabetes (3.5%) was lower than when combined with biochemical assessments (6.2%; 7.2%).DiscussionWhile not statistically significant, diabetes and prediabetes were higher with greater BMI, in older participants, urban residents and more recent publications. Diabetes and prediabetes were not significantly different by HIV‐related factors, including CD4 count and ART.ConclusionsAlthough HIV‐related factors did not modify prevalence, the diabetes burden in African PLHIV was considerable with suboptimal detection, and likely influenced by traditional risk factors. Furthermore, high prediabetes prevalence foreshadows substantial increases in future diabetes in African PLHIV.
Subject
Infectious Diseases,Public Health, Environmental and Occupational Health
Cited by
1 articles.
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