A total of 1203 participants were included in this study, with about two third (64%) females while 28 (2.3%) did not indicate their gender. The majority age group was 29 – 48 years, with about 60% of the participants belonging to this age group. About 33% of the participants had a CD4 count less than 200 cell/µL at the commencement of ART, with a large baseline CD4 count data missing (49.8%) as obtained from patients’ hospital records. Over two third were unemployed as indicated by respondents in the questionnaires. Besides the common opportunistic infections in PLWHIV, other comorbidities present were hypertension (1.0%), epilepsy (0.6%) and renal impairment (0.7%), totally making up 2.3% across the participants. (Table 1) Out of the eleven ART regimens prescribed for the patients, TDF/FTC/EFV was the most prescribed regimen (65%). (Table 2). Data in Table 1 and two were extracted from patients’ hospital records and analyzed.
Table 1. Demographic information of patients.
Variable
|
Frequency
|
Percentage (%)
|
Gender
|
|
|
Female
|
770
|
64.0
|
Male
|
405
|
33.7
|
Not indicated
|
28
|
2.3
|
Age in years
|
|
|
18-28
|
145
|
12.1
|
29-48
|
694
|
57.7
|
>48
|
313
|
26.0
|
Missing data
|
51
|
4.2
|
Baseline CD4
|
|
|
˂200 cells/µL
|
275
|
22.9
|
200-350 cells/µL
|
156
|
13.0
|
351-500 cells/µL
|
75
|
6.2
|
>500 cells/µL
|
98
|
8.1
|
Missing data
|
599
|
49.8
|
Employment status
|
|
|
Employed
|
384
|
31.9
|
Unemployed
|
801
|
66.6
|
Missing data
|
18
|
1.5
|
Opportunistic infections
|
|
|
Tuberculosis
|
90
|
7.5
|
Oral candidiasis
|
6
|
0.5
|
Hepatitis B
|
4
|
0.3
|
Herpes zoster
|
5
|
0.4
|
Diarrhoea
|
3
|
0.2
|
Septic cellulitis
|
2
|
0.2
|
Pneumonia
|
2
|
0.2
|
Other comorbidities
|
|
|
Hypertension
|
12
|
1.0
|
Epilepsy
|
7
|
0.6
|
Renal impairment
|
8
|
0.7
|
Table 2: Distribution of ART regimens prescribed
ART Regimen
|
Percentage (%)
|
ABC/3TC/EFV
|
13.5
|
ABC/FTC/EFV
|
0.1
|
D4T/3TC/EFV
|
0.7
|
TDF/3TC/NVF
|
0.3
|
TDF/FTC/ATVr
|
3.3
|
TDF/FTC/EFV
|
65
|
TDF/FTC/LPVr
|
4.5
|
TDF/FTC/NVP
|
3.1
|
ZDV/3TC/ATVr
|
1.9
|
ZDV/3TC/EFV
|
0.4
|
ZDV/3TC/LPVr
|
7.0
|
Prevalence of diabetes mellitus and outcome of diabetes management.
The prevalence of diabetes among persons living with HIV (PLWHIV) was 9%, [Fig 1]
Large percentage (61%) of those having diabetes were diagnosed while already on ART.
Almost half (47.1%) of those with diabetes remained with uncontrolled blood sugar (FBS ≥7 mm/L), having a mean FBS of 11.7 mmol/L. Data obtained using questionnaire and patients record, then analyzed.
Association between patient variables and diabetes mellitus among PLWHIV on ART.
Patients’ age and employment status were significantly associated (Cl, 95%) with diabetes among PLWHIV on ART. (Table 3)
Table 3. Association between patient variables and diabetes among PLWHIV taking ART.
Variables
|
Diabetes, n (%)
|
Total frequency, n (%)
|
Chi-square P-value
|
No
|
Yes
|
Gender
|
|
|
|
|
Male
|
363(92.4)
|
30(7.6)
|
393(34.6)
|
0.219
|
Female
|
669(90.2)
|
73(9.8)
|
742(65.4)
|
Age
|
|
|
|
|
18 – 28
|
139 (99.3)
|
1(0.7)
|
140(12.5)
|
0.000*
|
29-48
|
643(95.3)
|
32(4.7)
|
675(60.5)
|
>48
|
233(77.4)
|
68(22.6)
|
301(27.0)
|
Level of Education
|
|
|
|
|
No formal education
|
40(87.0)
|
6(13.6)
|
46(4.2)
|
0.109
|
Primary
|
175(87.1)
|
26(12.9)
|
201(18.5)
|
High school
|
601(92.2)
|
51(7.8)
|
652(60.0)
|
Tertiary
|
173(92.0)
|
15(8.0)
|
188(17.3)
|
Employment Status
|
|
|
|
|
Employed
|
349(93.6)
|
24(6.4)
|
373(32.6)
|
0.030*
|
unemployed
|
692(89.6)
|
80(10.4)
|
772(67.4)
|
Alcohol consumption
|
|
|
|
|
Yes
|
189(92.2)
|
16(7.8%)
|
205(18.1)
|
0.505
|
No
|
841(90.7)
|
86(9.3)
|
927(81.9)
|
Initial CD4 count (cells/mm3)
|
|
|
|
|
<200
|
234(88.6)
|
30(11.4)
|
264(44.9)
|
0.414
|
200 - 350
|
142(91.0)
|
14(9.0)
|
156(26.5)
|
351 - 500
|
68(93.2)
|
5(6.8)
|
73(12.4)
|
>500
|
89(93.7)
|
6(6.3)
|
95(16.2)
|
Current CD4 count (cells/mm3)
|
|
|
|
|
<200
|
50(94.3)
|
3(5.7)
|
53(8.3)
|
0.386
|
200 - 350
|
99(93.4)
|
7(6.6)
|
106(16.7)
|
351 - 500
|
133(90.5)
|
14(9.5)
|
147(23.1)
|
>500
|
293(88.8)
|
37(11.2)
|
330(51.9)
|
Initial viral load (copies/mm3)
|
|
|
|
|
High (≥100,000)
|
22(95.7)
|
1(4.3)
|
23(14.6)
|
0.137
|
Low (10,000 – 99,000)
|
19(79.2)
|
5(20.8)
|
24(15.3)
|
Lower (<10,000)
|
100(90.9)
|
10(9.1)
|
110(70.1)
|
Current viral load (cells/mm3)
|
|
|
|
|
‘Detectable’
|
340(90.9)
|
34(9.1)
|
374(59.0)
|
0.587
|
LTDL
|
233(89.6)
|
27(10.4)
|
260(41.0)
|
Key: * = Statistically significant
As can be seen from table 3 above, there was statistically significant association between the age and employment status of PLWHIV and having diabetes, at 95% confidence level.
Predictors of diabetes among PLWHIV on ART.
In a stepwise forward likelihood ratio multivariate logistic regression model, female gender and age were the predictors of diabetes in PLWHIV on ART. (table 4)
Table 4: Predictors of diabetes in PLWHIV on ART (Multi-covariate and uni-covariate logistic regression).
Variables
|
COR (95%CI)
|
COR P-Value
|
aOR(95%CI)
|
aOR P-Value
|
Gender
|
|
|
|
|
Male
|
0.76(0.49-1.18)
|
0.220
|
0.35(0.15-0.82)
|
0.016*
|
Female
|
1
|
|
1
|
|
Age
|
|
|
|
|
18 – 48
|
0.14(0.09-0.22)
|
0.000*
|
0.12(0.06-0.26)
|
0.000*
|
>48
|
1
|
|
1
|
|
Duration on ART
|
|
|
|
|
|
|
|
1(0.99-1.01)
|
0.473
|
Level of education
|
|
|
|
|
No formal education
|
1.73(0.63-4.74)
|
0.286
|
|
|
Primary
|
1.71(0.88-3.35)
|
0.115
|
|
|
High school
|
0.98(0.54-1.78)
|
0.944
|
|
|
Tertiary
|
1
|
|
|
|
Employment Status
|
|
|
|
|
Employed
|
0.60(0.37-0.96)
|
0.032*
|
|
|
unemployed
|
1
|
|
|
|
Alcohol consumption
|
|
|
|
|
Yes
|
0.83(0.48-1.44)
|
0.506
|
|
|
No
|
1
|
|
|
|
Baseline CD4 cells count
|
|
|
|
|
>200 cells/µL
|
|
|
1.90(0.91-3.98)
|
0.088
|
≤200 cells/µL
|
|
|
1
|
|
Current CD4 cells count
|
|
|
|
|
>200 cells/µL
|
|
|
1.04(0.25-4.32)
|
0.957
|
≤200 cells/µL
|
|
|
1
|
|
Keys: 1 = the reference category; COR= Crude Odd Ratio; CI= Confidence interval; aOR = Adjusted Odd Ratio (Logistic regression).
The probability for diabetes mellitus in male PLWHIV on ART was 65% less than that of females (aOR = 0.35, 95% Cl= 0.15-0.82, P-value=0.016). (table 4)
The likelihood of diabetes mellitus in PLWHIV on ART who were between the ages 18 and 48 years was 88% less than those that were older than 48 years. (aOR = 0.12, 95% Cl= 0.06-0.26, P-value=0.000). (Table 4)