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Incidence and prevalence of type 2 diabetes mellitus with HIV infection in Africa: a systematic review and meta-analysis.

Citation
Prioreschi, A., et al. “Incidence And Prevalence Of Type 2 Diabetes Mellitus With Hiv Infection In Africa: A Systematic Review And Meta-Analysis.”. Bmj Open, p. e013953.
Center Vanderbilt University
Author A Prioreschi, R J Munthali, L Soepnel, J A Goldstein, L K Micklesfield, D M Aronoff, S A Norris
Keywords Africa, HIV, type 2 diabetes mellitus, combination antiretroviral therapy, Incidence, Prevalence
Abstract

OBJECTIVES: This systematic review aims to investigate the incidence and prevalence of type 2 diabetes mellitus (T2DM) in patients with HIV infection in African populations.

SETTING: Only studies reporting data from Africa were included.

PARTICIPANTS: A systematic search was conducted using four databases for articles referring to HIV infection and antiretroviral therapy, and T2DM in Africa. Articles were excluded if they reported data on children, animals or type 1 diabetes exclusively.

MAIN OUTCOME MEASURES: Incidence of T2DM and prevalence of T2DM. Risk ratios were generated for pooled data using random effects models. Bias was assessed using an adapted Cochrane Collaboration bias assessment tool.

RESULTS: Of 1056 references that were screened, only 20 were selected for inclusion. Seven reported the incidence of T2DM in patients with HIV infection, eight reported the prevalence of T2DM in HIV-infected versus uninfected individuals and five reported prevalence of T2DM in HIV-treated versus untreated patients. Incidence rates ranged from 4 to 59 per 1000 person years. Meta-analysis showed no significant differences between T2DM prevalence in HIV-infected individuals versus uninfected individuals (risk ratio (RR) =1.61, 95% CI 0.62 to 4.21, p=0.33), or between HIV-treated patients versus untreated patients (RR=1.38, 95% CI 0.66 to 2.87, p=0.39), and heterogeneity was high in both meta-analyses (I=87% and 52%, respectively).

CONCLUSIONS: Meta-analysis showed no association between T2DM prevalence and HIV infection or antiretroviral therapy; however, these results are limited by the high heterogeneity of the included studies and moderate-to-high risk of bias, as well as, the small number of studies included. There is a need for well-designed prospective longitudinal studies with larger population sizes to better assess incidence and prevalence of T2DM in African patients with HIV. Furthermore, screening for T2DM using gold standard methods in this population is necessary.

TRIAL REGISTRATION NUMBER: PROSPERO42016038689.

Year of Publication
2017
Journal
BMJ open
Volume
7
Issue
3
Number of Pages
e013953
Date Published
12/2017
ISSN Number
2044-6055
DOI
10.1136/bmjopen-2016-013953
Alternate Journal
BMJ Open
PMID
28360243
PMCID
PMC5372101
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