Prevalence and determinants of glucose intolerance among HIV/AIDS patients in north-central Nigeria

Abstract

Background: The advent of potent antiviral drugs has revolutionalised the clinical course of HIV / AIDS resulting in increased survival and improved quality of life. Metabolic derangements in HIV infected patients are becoming more common probably due to this increased survival from the use of HAART. There is limited data on the occurrence of glucose intolerance among HIV patients in Nigeria.

Objective: To determine the prevalence of glucose intolerance and associated risk factors in HIV/AIDS patients.

Methods: Consenting adult HIV patients at the HIV clinic of the Jos University Teaching Hospital (JUTH), Jos , Nigeria were evaluated were evaluated for the presence of glucose intolerance using a 75g oral glucose tolerance test (OGTT). There clinical characteristics, anthropometry, CD4 cell counts and viral load were determined using appropriate standard techniques. Impaired Fasting Glucose (IFG), Impaired Glucose Tolerance (IGT), and Diabetes Mellitus (DM) were defined based on the American Diabetes Association (ADA) cut-off values.

Results: Of the 584 patients studied, 384 (130 males and 251 females) with mean±SD age of 38±15 years were HAARTtreated; while 200 (61 males and 139 females) with mean±SD age of 33±17 years were HAART-naive. Overall, the prevalence of GI was 40.4% (IFG) 19.5%, IGT 11.5% and DM 9.4%. The prevalence of IFG (27.1%) and DM (11.2%) in HAART - treated patients were observed and those in HAART-naive patients were (IFG 5.0%,DM 6.0%), p<0.005. IGT was more prevalent in HAART-naive than in HAART-treated patients (19.5%, and 7.3% respectively), p<0.05. The proportions of patients with GI were higher in overweight and obese HAART-treated patients with moderate CD4 cell count (200-500 x10⁶ cell/L); while in the HAART-naive patients, GI was more prevalent in underweight subjects with CD4 cell count (<200 x 10⁶ cell/L). The Determinants of GI were age, increasing BMI, low CD4 cell count, metabolic syndrome and HAART treatment duration. The independent predictors of glucose intolerance in HIV / AIDS patients were low CD4 cell count and prolonged HAART treatment duration.

Conclusion: The prevalence of GI among HIV/AIDS patients in North-Central Nigeria is high. Treatment with HAART and low CD4 cell count are strong determinants of glucose intolerance in our HIV / AIDS patients. Regular screening for glucose intolerance among our HIV / AIDS patients is recommended.

Keywords: HIV, Glucose Intolerance, Prevalence, North-Central Nigeria