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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
Time on ART
1 to 5 years 83 41.5
6 years and above 117 58.5
Blood sugar status
Normal (<6.0mmol/L) 185 92.5
Diabetes (≥7.0mmol/L) 15 7.5
Location
Urban 180 90.0
Rural 20 10.0
Total 200 100
Table 1:- Socio-Demographic and Clinical Characteristics of 200 HIV-Infected Adults on ART at Mulago National Referral
Hospital ART-Clinic Uganda.
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.
IJISRT19AUG593 www.ijisrt.com 3
Volume 4, Issue 8, August – 2019 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
Characteristics Number(%) with Diabetes 95CI Fisher`s exact P value
Sex
Male 4(5.3) [1.3, 10.7] 0.421
Female 11(8.8) [4.0, 14.4]
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
Obese and overweight patients were found to be 2 in 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
IV. DISCUSSION AND CONCLUSION means a higher risk of insulin resistance, because fat
interferes with the body's ability to use insulin. Another
This is the first study to report diabetes among HIV observation was the relationship between treatments and
patients on ART in Uganda, we aimed to determine the diabetes, in this study we also observed that patients on
prevalence and potential factors for diabetes among HIV- second line drug combination with ritonavir-boosted
infected patients on ART at Mulago national referral atazanavir (ATV/r-protease inhibitor) were 3 times more
hospital Uganda. The overall prevalence estimate for likely to have diabetes compared to those on first line and
diabetes mellitus was 7.5%. We have found a high this could be as a result of much effects exerted on the liver
prevalence of diabetes among HIV-infected adults on ART and the pancreas by these drugs, and due to drug failure,
compared to what was reported in the general population- patients end up administering very many drug types with a
based study done by (Bahendeka, et al., 2016) and this wide range of side effects on their internal system. The
could be as a result of little or missed attention, care and study also showed that patients using both ART especially
support opportunities associated with metabolic imbalance second line regimen and Anti-hypertensive drugs were at a
management among these patients. very greater risk of getting diabetes mellitus compared to
those who were only ART and this could be as a results of
According to the study done by (Hernandez et al., multiple metabolic effects of combinatorial drug therapy
2017) in USA reported a higher diabetes prevalence (ART) for HIV infection exerted on the internal organs
estimate of 10.3%, while (Abebe, et al., 2016), reported the during drug metabolism most especially in the liver and the
diabetes prevalence estimate of 5.1% among the HIV- pancreas where insulin is secreted. We also observed a
infected patients receiving ART in follow-up care at higher prevalence of diabetes mellitus among patients from
University of Gondar Hospital, Northwest Ethiopia and the urban areas around Kampala compared to those from rural
difference that exits with our study could be as a result of areas and this could be due to the fact that the selected
the heterogenecity of diabetes across the communities, and study site was in an urban area where medical information
also from differences in health determinants such as life suggests presence of higher burden of metabolic disorders
style across the populations and also the larger sample size even among groups without HIV-infection, and also the
used in these studies. When compared our results with sedentary lifestyle that most of these people live.
those reported from the study done by (Shankalala, et al.,
2017) who reported a slightly lower diabetes prevalence of According to this study Diabetes mellitus prevalence
5.0% in their study among patients on ART, the difference among HIV-infected sub-population on ART is high
that exists with our results could be because the different compared to what is reported in the general population of
studies may have used different ways of measuring and Uganda, suggesting little attention, care and support
defining diabetes, and also different diagnosis methods in opportunities associated with metabolic imbalance
HIV settings. management among patients on ART.
In this study we also observed that overweight or BMI, Hypertension, second line drugs and use of
obese patients were significantly more likely to have Anti-hypertensive drugs were found to be the major factors
diabetes compared to normal and underweight patients and associated with Diabetes mellitus among HIV-infected
this is because insulin resistance correlates with increased adults receiving anti-retroviral therapy.
weight gain and obesity and yet initiation of ART itself is
associated with rapid weight gain which leads many
patients to become overweight thereby putting them at a
greater risk of getting diabetes, and also greater weight