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ISSN No:-2456-2165
Gender
Female 125 62.5
Male 75 37.5
Age (years)
20-34 50 25.0
35-44 71 35.5
45 and above 79 39.5
Body mass index (kg/m2)
Underweight (<18.5) 11 5.5
Normal weight (18.5 to 24.5) 105 52.5
Overweight (25 to 29.9) 61 30.5
Obese (≥30) 23 11.5
Blood pressure (mmHg)
Normal 154 77.0
Hypertension 46 23.0
B. Prevalence of Diabetes Mellitus among HIV-Infected 9.6% (95%CI: 3.5, 14.8) among patients who have been on
Patients on Art ART for a period of 6 years and above. The prevalence was
The overall prevalence of diabetes mellitus was 7.5% 5.2% (95%CI: 1.3, 9.1) among those who had a normal
(95%CI: 3.5, 11.5), with males at 5.3% (95%CI: 1.3, 10.7) blood pressure, and as high as 15.2% (95%CI: 4.4, 23.9)
and 8.8% (95%CL: 4.0, 14.4) among females, 6% (95%CI: among patients with high blood pressure. The prevalence of
0, 14) among patients aged 20 to 34 years, 2.8% (95%CI: 0, diabetes was 18.2% (95%CI: 0.0, 45.5) among patients who
7) among those aged 35 to 44 years and 12.7% (95%CI: were underweight, 2.9% (95%CI: 0.0, 5.7) among those
3.9, 18.1) among patients aged 45 years and above, 20.5% with normal weight, 8.2% (95%CI: 1.7, 16.4) among
(95%CI:7.7, 35.9) among patients who use both ART and overweight patients and as high as 21.7% (95%CI: 4.3,
Anti-hypertensive drugs, and 4.3% (95%CI:1.9, 7.5) among 43.5) among obese patients. The prevalence was 7.8%
those who don`t use anti-hypertensive drugs. Basing on the (95%CI: 3.9, 12.2) among urban residents, and 5.3%
time on ART, the prevalence was 4.8% (95%CI: 1.2, 12.0) (95%CI: 0.0, 15.8) among rural residents as shown in table
among those who have been on ART for 1 to 5 years, and 2 below.
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Volume 4, Issue 8, August – 2019 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
Age (years)
20 – 34 3(6) [0, 14]
35 – 44 2(2.8) [0, 7] 0.124
45 and above 10(12.7) [3.9, 18.1]
Use of Anti-hypertensive
Yes 8(20.5) [7.7, 35.9]
No 7(4.3) [1.9, 7.5] 0.002
Blood Pressure
Normal 8(5.2) [1.3, 9.1] 0.048
Hypertension 7(15.2) [4.4, 23.9]
Time on ART
1 to 5 years 4(4.8) [1.2, 12.0] 0.283
6 years and above 11(9.6) [3.5, 14.8]
Current ART-Line
1st Line 4(2.6) [0.6, 5.2] 0.001
2nd Line 11(23.9) [13.0, 39.1]
Location
Urban 14(7.8) [3.9, 12.2] 1.000
Rural 1(5.3) [0.0, 15.8]
Table 2. Prevalence of Diabetes Mellitus among HIV-Infected Adults on ART by Background Characteristics at Mulago National
Hospital ART Clinic Uganda
C. Risk Factors of Diabetes Mellitus among HIV-Infected were 3 times more likely to have diabetes mellitus
Adults on ART compared to those who were on first line drugs, as shown in
Obese and overweight patients were found to be 2 table 3 below. History of anti-hypertensive drug use was
times more likely to have diabetes mellitus compared to found to be independently associated with diabetes mellitus
those with normal BMI or underweight while those who among HIV-infected adults on ART.
had high blood pressure were also almost 2 times more
likely to have diabetes. Patients on second line treatment
BMI
Underweight/Normal 1
Overweight 2.943[2.9, 123.6] 0.002
Obese 1.935[1.2, 40.3] 0.031
Blood pressure
Normal 1
Hypertension 1.529[1.2, 17.4] 0.024
Current ART-Line
1st Line 1
2nd Line 3.420[2.1, 25.3] 0.005
Table 3. Risk Factors of Diabetes among HIV-infected patients on ART at Mulago National Referral Hospital
IV. DISCUSSION AND CONCLUSION greater risk of getting diabetes, and also greater weight
means a higher risk of insulin resistance, because fat
This is the first study to report diabetes among HIV interferes with the body's ability to use insulin. Another
patients on ART in Uganda, we aimed to determine the observation was the relationship between treatments and
prevalence and potential factors for diabetes among HIV- diabetes, in this study we also observed that patients on
infected patients on ART at Mulago national referral second line drug combination with ritonavir-boosted
hospital Uganda. The overall prevalence estimate for atazanavir (ATV/r-protease inhibitor) were 3 times more
diabetes mellitus was 7.5%. We have found a high likely to have diabetes compared to those on first line and
prevalence of diabetes among HIV-infected adults on ART this could be as a result of much effects exerted on the liver
compared to what was reported in the general population- and the pancreas by these drugs, and due to drug failure,
based study done by (Bahendeka, et al., 2016) and this patients end up administering very many drug types with a
could be as a result of little or missed attention, care and wide range of side effects on their internal system. The
support opportunities associated with metabolic imbalance study also showed that patients using both ART especially
management among these patients. second line regimen and Anti-hypertensive drugs were at a
very greater risk of getting diabetes mellitus compared to
According to the study done by (Hernandez et al., those who were only ART and this could be as a results of
2017) in USA reported a higher diabetes prevalence multiple metabolic effects of combinatorial drug therapy
estimate of 10.3%, while (Abebe, et al., 2016), reported the (ART) for HIV infection exerted on the internal organs
diabetes prevalence estimate of 5.1% among the HIV- during drug metabolism most especially in the liver and the
infected patients receiving ART in follow-up care at pancreas where insulin is secreted. We also observed a
University of Gondar Hospital, Northwest Ethiopia and the higher prevalence of diabetes mellitus among patients from
difference that exits with our study could be as a result of urban areas around Kampala compared to those from rural
the heterogenecity of diabetes across the communities, and areas and this could be due to the fact that the selected
also from differences in health determinants such as life study site was in an urban area where medical information
style across the populations and also the larger sample size suggests presence of higher burden of metabolic disorders
used in these studies. When compared our results with even among groups without HIV-infection, and also the
those reported from the study done by (Shankalala, et al., sedentary lifestyle that most of these people live.
2017) who reported a slightly lower diabetes prevalence of
5.0% in their study among patients on ART, the difference
that exists with our results could be because the different CONCLUSION
studies may have used different ways of measuring and
defining diabetes, and also different diagnosis methods in According to this study Diabetes mellitus prevalence
HIV settings. among HIV-infected sub-population on ART is high
compared to what is reported in the general population of
In this study we also observed that overweight or Uganda, suggesting little attention, care and support
obese patients were significantly more likely to have opportunities associated with metabolic imbalance
diabetes compared to normal and underweight patients and management among patients on ART.
this is because insulin resistance correlates with increased
weight gain and obesity and yet initiation of ART itself is BMI, Hypertension, second line drugs and use of
associated with rapid weight gain which leads many Anti-hypertensive drugs were found to be the major factors
patients to become overweight thereby putting them at a associated with Diabetes mellitus among HIV-infected
adults receiving anti-retroviral therapy.
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Volume 4, Issue 8, August – 2019 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
RECOMMENDATION patients on ART in the Copperbelt Province of Zambia.
Journal of Diabetes & Metabolic Disorders. 2017 Dec;
16(1):29.
Based on the result obtained from this study early
[12]. Shaw JE, Sicree RA, Zimmet PZ. Global estimates of
screening of patients who use both ART and Anti- the prevalence of diabetes for 2010 and 2030.
hypertensive drugs, as well as those that are overweight and Diabetes Res Clin Pract 2010; 87 (January (1)):4–14.
obese must be included into regular HIV clinical care set up [13]. TIERNEY LM, MCPHEE SJ, PAPADAKIS MA.
as part of the overall care and support strategy for early Current medical Diagnosis & Treatment. 40th Ed.
management of diabetes mellitus, and clinicians must also New York: Lange Medical Books/McGraw-Hill;
consider the metabolic effects of multiple drug therapy for 2001.
[14]. Whiting DR, Guariguata L, Weil C, and Shaw J. IDF
HIV infection and its outcome. Nonetheless there is still
Diabetes Atlas: global estimates of the prevalence of
need to invest in additional research with larger sample size diabetes for 2011 and 2030. Diabetes Res Clin Pract
so as to increase the evidence critical in primary care 2011; 94 (December (3)):311–21.
strategies which directly impact on secondary care and [15]. World Health Organization. Global report on diabetes.
support programmes. World Health Organization; 2016.
[16]. World Health Organization. Global status report on
REFERENCES non-communicable diseases 2014. Geneva, 2014.
(Available from
[1]. Abebe SM, Getachew A, Fasika S, Bayisa M, http://www.who.int/nmh/publications/ncd-
Demisse AG, Mesfin N. Diabetes mellitus among statusreport- 2014/en/pdf) [5 May 2015].
HIV-infected individuals in follow-up care at
University of Gondar Hospital, Northwest Ethiopia.
BMJ open. 2016 Aug 1; 6(8):e011175.
[2]. Bahendeka S, Wesonga R, Mutungi G, Muwonge J,
Neema S, Guwatudde D. Prevalence and correlates of
diabetes mellitus in Uganda: a population‐based
national survey. Tropical Medicine & International
Health. 2016 Mar; 21 (3):405-16
[3]. Bi Y, Wang T, Xu M, Xu Y, Li M, Lu J, Zhu X, Ning
G. Advanced research on risk factors of type 2
diabetes. Diabetes/metabolism research and reviews.
2012 Dec; 28:32-9.
[4]. Capeau J, et al. Ten-year diabetes incidence in 1046
HIV-infected patients started on a combination
antiretroviral treatment. AIDS. 2012; 26 (3):303–14.
[5]. Florescu D, Kotler DP. Insulin resistance, glucose
intolerance and diabetes mellitus in HIV-infected
patients. Antivir Ther 2007; 12:149–162.
[6]. Hernandez-Romieu AC, Garg S, Rosenberg ES,
Thompson-Paul AM, Skarbinski J. Is diabetes
prevalence higher among HIV-infected individuals
compared with the general population? Evidence from
MMP and NHANES 2009–2010. BMJ Open Diabetes
Research and Care. 2017 Jan 1; 5(1):e000304.
[7]. International Diabetes Federations. IDF Diabetes
Atlas, 2013. (Available from:
http://www.idf.org/diabetesatlas) [5May 2015].
[8]. Mohammed M, Mengistie B, Dessie Y, Godana W.
Prevalence of depression and associated factors
among HIV patients seeking treatments in ART
clinics at Harar Town, Eastern Ethiopia. Journal of
AIDS & Clinical Research. 2015; 6(6):474.
[9]. ROTHER KI. Diabetes treatment-bridging the divide.
N Engl J Med 2007; 15: 1499-1501
[10]. Samaras K. Prevalence and pathogenesis of diabetes
mellitus in HIV-1 infection treated with combined
antiretroviral therapy. J Acquir Immune Defic Syndr
2009; 50:499–505.
[11]. Shankalala P, Jacobs C, Bosomprah S, Vinikoor M,
Katayamoyo P, Michelo C. Risk factors for impaired
fasting glucose or diabetes among HIV infected
IJISRT19AUG593 www.ijisrt.com 204