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Incidence and Risk Factors for Prediabetes and Diabetes Mellitus Among HIV-infected Adults on Antiretroviral Therapy

A Systematic Review and Meta-analysis

Nansseu, Jobert Richiea,b; Bigna, Jean Joelc,d; Kaze, Arnaud D.e; Noubiap, Jean Jacquesf

doi: 10.1097/EDE.0000000000000815
Infectious Diseases

Objective: To summarize evidence on the rates and drivers of progression from normoglycemia to prediabetes and/or diabetes mellitus (hereafter “diabetes”) in antiretroviral treatment (ART)–exposed HIV-infected people.

Methods: We searched EMBASE, PubMed, Web of Science, and Global Index Medicus to identify articles published from 1 January 2000 to 30 April 2017. A random-effects model produced a summary estimate of the incidence across studies and heterogeneity was assessed using Cochrane’s Q statistic.

Results: We included 44 studies, whose methodologic quality was high with only 10 (30%) medium-quality studies and none of low quality. There was substantial heterogeneity between studies in estimates of the incidence of diabetes and prediabetes. The pooled incidence rate of overt diabetes and prediabetes were 13.7 per 1,000 person-years of follow-up (95% CI = 13, 20; I2 = 98.1%) among 396,496 person-years and 125 per 1,000 person-years (95% CI = 0, 123; I2 = 99.4) among 1,532 person-years, respectively. The major risk factors for diabetes and prediabetes were aging, family history of diabetes, Black or Hispanic origin, overweight/obesity, central obesity, lipodystrophy/lipoatrophy, dyslipidemia, metabolic syndrome, increased baseline fasting glycemia, and certain ART regimens.

Conclusions: These data highlight the important and fast-increasing burden of diabetes and prediabetes among the ART-exposed HIV-infected population. More research is needed to better capture the interplay between prediabetes/diabetes and ART in HIV-infected patients, considering the increasing number of ART-exposed patients subsequent to the World Health Organization’s recommendation of initiating ART at HIV infection diagnosis regardless of CD4 count and age.

From the aDepartment of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon; bDepartment of Disease, Epidemics and Pandemics Control, Ministry of Public Health, Yaoundé, Cameroon; cDepartment of Epidemiology and Public Health, Centre Pasteur of Cameroon, Yaoundé, Cameroon; dSchool of Public Health, Faculty of Medicine, University of Paris Sud XI, Le Kremlin Bicêtre, Paris, France; eDivision of Renal Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA; and fDepartment of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa.

Submitted March 4, 2017; accepted January 30, 2018.

J.R.N., J.J.B., A.D.K., and J.J.N. conceived the study, designed, and wrote the protocol. J.R.N., J.J.B., and A.D.K. did the literature search. J.R.N., J.J.B., A.D.K., and J.J.N. selected the studies and extracted the relevant information. J.R.N., J.J.B., and A.D.K. synthesized the data. J.R.N., J.J.B., J.J.N., and A.D.K wrote the first draft of the article. J.R.N., J.J.B., A.D.K., and J.J.N. critically revised successive drafts of the article and approved the final version. J.R.N. is the guarantor of the review.

The authors report no conflicts of interest.

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Correspondence: Jean Jacques N. Noubiap, Department of Medicine, University of Cape Town and Groote Schuur Hospital, 7925 Observatory, Cape Town, South Africa. E-mail:

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