In this study 9% of the participants living with HIV (PLWHIV) had diabetes (figure 1). South Africa, where the study was conducted has a high HIV prevalence as 20.4% of adults between the ages of 15 and 49 live with HIV [14]. In addition, the prevalence of diabetes among South Africa’s adult general population was 5.4%. [15], yet the prevalence of diabetes among PLWHIV was much higher at 9%. As shown in this study.
This high prevalence of diabetes among PLWHIV as shown in our study, is consistent with findings by some other earlier studies [16,17,18,12]. However, a study by Diabetes Focus eMag [19] indicated that prevalence of diabetes among PLWHIV is similar to that among the general population. This difference in findings by different studies may be due to differences in the prevalence of diabetes amongst different populations, or differences in participant’s lifestyles.
Another finding from this study relating to gender has shown that the prevalence of diabetes among females PLWHIV was higher (9.5%) than that of males (7.4%). This finding is similar with a study by Hernandez-Ronieu et al, where in 2017 [20], it was shown that the prevalence of diabetes among females living with HIV was higher than that of males living with HIV. However, the same study showed that the prevalence of diabetes is higher in males among the general population. Furthermore, in this South African study it was found that female gender is a predictor for diabetes in PLWHIV, as males living with HIV were 65% less likely to have diabetes than females (table 4). This finding was similar with other studies which indicated that female who are HIV positive are more likely to have non-communicable diseases (NDC) co-morbidity. [21,22]. Hence, females living with HIV should be screened for diabetes repeatedly at close interval, in other to detect diabetes early and manage them accordingly.
Though this study found that 61% of the PLWHIV were diagnosed with diabetes after the commencement of antiretroviral therapy, there was no significant association found between when ART was commenced and the incidence of diabetes mellitus. Earlier studies vary in their findings with regards to the association between ART and diabetes, with some studies showing similar results to this study [19], while other studies were contrary to the findings of this study, in that, they showed association between ART and diabetes [23,16,17,18]. People who test positive for HIV should be tested for diabetes before the commencement of ART and periodically thereafter.
Almost half (47.1%) of the PLWHIV with diabetes in this study remained with uncontrolled blood sugar (Mean FBS of 11.7 mmol/L), this is particularly of concern, as this predisposes them to diabetic complications such as retinopathy, neuropathy, nephropathy among others. These complications, if allowed to occur will further increase the disease burden and pill burden for this group of patients. Therefore, this study further sheds light on this issue to help clinicians understand the burden of diabetes among PLWHIV and appreciate the possible impact of uncontrolled blood sugar among these patients, with a view to mitigating the impact of the convergence of these chronic conditions by ensuring effective management of diabetes among persons living with HIV.
This study also showed that older age is a predictor to diabetes in PLWHIV, such that the likelihood of diabetes for those older than 48 years of age was 88% compared to those that are younger than 48 years of age (table 4). This is similar with other studies which showed that old age is a risk factor to chronic comorbidities in PLWHIV. [21,22]. As ART increases the life span of PLWHIV, predisposing them to chronic medical conditions such as diabetes, clinicians should give adequate attention to diabetes in PLWHIV as they do to other comorbidities.
However, the current (at the time of the study) blood sugar measurement for some of the patients with diabetes were missing, this might have affected the level of accuracy of the mean fasting blood sugar found in this study (11.7 mmol/L).
Conclusion/recommendations
In KwaZulu-Natal, the prevalence of HIV among PLWHIV (9%) was higher than that of the general population (5.4%), the prevalence among females was higher (9.5%) than that of males (7.4%) and predictors of diabetes among PLWHIV were female gender and older age. About half (47.1%) of the people with diabetes had uncontrolled blood sugar with a mean FBS of 11.7 mm/L. There was no association between ART and diabetes. People who test positive to HIV should be tested for diabetes before the commencement of ART, this is to further study the possible association between ART and HIV as some studies indicated. Regular and continuous testing for diabetes should be carried out and those found to be diabetic should be adequately managed to prevent diabetic complications as well as prevent possible interference with the outcomes of managing HIV.