• HIV/AIDS
• Meta-analysis
• Non-communicable diseases
• People living with HIV
• Sub-Saharan Africa
• Systematic review

• Antiretroviral therapy
• Dynamic change
• Fasting plasma glucose
• Human immunodeficiency virus
• Long-term

Investigate the relationship between two common cardiovascular diseases and HIV in adults living in sub-Saharan Africa using population data provided through the Demographic and Health Survey.

Data for four sub-Saharan countries were used. All adults asked questions regarding diagnosis of HIV, diabetes, and hypertension were included in the sample totaling 5356 in Lesotho, 3294 in Namibia, 9917 in Senegal, and 1051 in South Africa. Logistic models were run for each country separately, with self-reported diabetes as the first outcome and self-reported hypertension as the second outcome and HIV status as the primary independent variable. Models were adjusted for age, gender, rural/urban residence and BMI. Complex survey design allowed weighting to the population.

Prevalence of self-reported diabetes ranged from 3.8% in Namibia to 0.5% in Senegal. Prevalence of self-reported hypertension ranged from 22.9% in Namibia to 0.6% in Senegal. In unadjusted models, individuals with HIV in Lesotho were 2 times more likely to have self-reported diabetes (OR = 2.01, 95% CI 1.08–3.73), however the relationship lost significance after adjustment. Individuals with HIV were less likely to have self-reported diabetes after adjustment in Namibia (OR = 0.29, 95% CI 0.12–0.72) and less likely to have self-reported hypertension after adjustment in Lesotho (OR = 0.63, 95% CI 0.47–0.83). Relationships were not significant for Senegal or South Africa.

HIV did not serve as a risk factor for self-reported cardiovascular disease in sub-Saharan Africa during the years included in this study. However, given the growing prevalence of diabetes and hypertension in the region, and the high prevalence of undiagnosed cardiovascular disease, it will be important to continue to track and monitor cardiovascular disease at the population level and in individuals with and without HIV.

The odds of self-reported diabetes in individuals with HIV was high in Lesotho and low in Namibia, while the odds of self-reported hypertension in individuals with HIV was low across all 4 countries included in this study. Programs are needed to target individuals that need to manage multiple diseases at once and should consider increasing access to cardiovascular disease management programs for older adults, individuals with high BMI, women, and those living in urban settings.

• Cardiovascular disease
• Demographic and Health Survey
• Diabetes
• HIV
• Hypertension

The burden of diabetes mellitus in Sub-Saharan Africa is growing rapidly, and yet the prevalence and patient characteristics are still largely unknown.

We analyzed clinical and demographic characteristics of Type 2 diabetes (T2DM) patients attending a diabetes clinic in Guinea-Bissau from February 2008 to April 2014, and estimated the prevalence and risk factors of unknown-impaired fasting plasma glucose (FPG) and diabetes, as well as excess mortality associated with T2DM.

We characterized T2DM patients attending the national diabetes clinic in Bissau. Diabetes was diagnosed based on FPG. We matched T2DM patients 1:1 with non-diabetes community controls on age and sex to determine relevant risk factors for T2DM using logistic regression. Furthermore, we matched patients 1:6 with community controls to assess long-term survival (until February 2019) in a Cox regression using calendar time as the underlying timescale. Verbal autopsies determined the cause of death among T2DM patients and controls.

The mean age among T2DM was 50.6 (SD 11.1), and the mean FPG at first consultation was high (13.2 mmol/L (SD 5.1)). Ethnicity, family history of diabetes, hypertension, and anthropometrics differed among T2DM patients, community controls with impaired FPG, and healthy controls. Family history of diabetes (OR = 5.65, 95% CI: 3.10–10.3) and elevated waist circumference (2.33, 1.26–4.29) were significant risk factors for T2DM. 20.4% (59/289) of community controls had abnormal FPG. T2DM patients had an excess mortality hazard ratio of 3.53 (95%CI: 1.92–6.52). Deaths caused by bacterial infections, including foot ulcers, were more common among T2DM patients, compared with community controls (54% (7/13) vs. 19% (5/27) (P = 0.02)).

Several risk factors including were associated with T2DM in Guinea-Bissau. We found a high prevalence of elevated FPG among randomly selected community controls. In combination with higher mortality among T2DM patients, an urgent need for better treatment options and increased awareness.

• Africa
• Guinea-Bissau
• Type 2 diabetes mellitus
• community burden
• mortality
• risk factors

• ART-naïve
• Ethiopia
• HIV
• metabolic syndrome
• sub-Saharan Africa

• glycemic control
• human immunodeficiency virus
• self-care behavior
• treatment outcome

• Jimma Universit

Two HIV virus types exist: HIV-1 is pandemic and aggressive, whereas HIV-2 is confined mainly to West Africa and less pathogenic. Despite the fact that it has been almost 40 years since the discovery of AIDS, there is still no cure or vaccine against HIV. Consequently, the concepts of functional vaccines and cures that aim to limit HIV disease progression and spread by persistent control of viral replication without life-long treatment have been suggested as more feasible options to control the HIV pandemic. To identify virus-host mechanisms that could be targeted for functional cure development, researchers have focused on a small fraction of HIV-1 infected individuals that control their infection spontaneously, so-called elite controllers. However, these efforts have not been able to unravel the key mechanisms of the infection control. This is partly due to lack in statistical power since only 0.15% of HIV-1 infected individuals are natural elite controllers. The proportion of long-term viral control is larger in HIV-2 infection compared with HIV-1 infection. We therefore present the idea of using HIV-2 as a model for finding a functional cure against HIV. Understanding the key differences between HIV-1 and HIV-2 infections, and the cross-reactive effects in HIV-1/HIV-2 dual-infection could provide novel insights in developing functional HIV cures and vaccines.

• Disease progression
• Dual-infection
• Functional cure
• HIV-1
• HIV-2
• West Africa

Adrenal insufficiency (AI) is rarely diagnosed in patients with HIV infection, in spite of autopsy studies showing very high rates of adrenal involvement. This study was aimed to determine the presence, patterns and predictors of AI in patients with HIV infection.

Consecutive HIV patients, 18-70 yr age, without any severe co-morbid state, having at least one-year follow up at the antiretroviral therapy clinic, underwent clinical assessment and hormone assays.

From initially screened 527 patients, 359 patients having good immune function were analyzed. Basal morning cortisol <6 μg/dl (<165 nmol/l; Group 1), 6-11 μg/dl (165-300 nmol/l; Group 2), 11-18 μg/dl (300-500 nmol/l; Group 3) and ≥18 μg/dl (500 nmol/l; Group 4) were observed in 13, 71, 199 and 76 patients, respectively. Adrenocorticotropic hormone (ACTH) stimulation test revealed 87 patients (24.23%) to have AI. AI in groups 1-4 was 100, 56.34, 17.09 and 0 per cent, respectively. AI patients were more likely to be females (P< 0.05), having longer disease duration (P< 0.05), immune reconstitution inflammatory syndrome, hyperkalaemia (P< 0.01), lower fasting glucose (P< 0.01), dehydroepiandrosterone sulphate (DHEAS) and vitamin D. Regression analysis revealed morning cortisol and DHEAS to be best predictors of AI (P=0.004 and 0.028, respectively).

AI is a significant problem in HIV-infected individuals, observed in nearly a quarter of patients. Diagnosis warrants high index of suspicion and low threshold for screening, especially in those having low DHEAS and hyperkalaemia. Morning cortisol is a reasonable screening test, with ACTH stimulation warranted to confirm diagnosis, especially in patients with morning cortisol <11 μg/dl (300 nmol/l).

• Acton prolongatum
• HIV
• adrenal insufficiency
• adrenocorticotropic hormone
• dehydroepiandrosterone-sulphate
• hypoadrenalism
• synacthen
• vitamin D

• Adult
• Age Factors
• Anti-HIV Agents/therapeutic use
• Antiretroviral Therapy, Highly Active
• Biomarkers/blood
• Blood Glucose/metabolism
• Body Mass Index
• C-Peptide/blood
• CD4 Lymphocyte Count
• Case-Control Studies
• Cell-Free Nucleic Acids/blood
• Fasting
• Female
• HIV Infections/drug therapy
• HIV Infections/immunology
• HIV Infections/metabolism
• HIV Infections/physiopathology
• Humans
• Immune Reconstitution
• Insulin/blood
• Insulin Resistance
• Insulin-Secreting Cells/drug effects
• Insulin-Secreting Cells/immunology
• Insulin-Secreting Cells/pathology
• Male
• Middle Aged
• Proinsulin/blood
• Protein Precursors/blood
• Sex Factors
• Smoking/physiopathology

• UC4 DK104166 NIDDK NIH HHS
• R01 DK060581 NIDDK NIH HHS
• UL1 TR001108 NCATS NIH HHS
• P30 DK097512 NIDDK NIH HHS
• C06 RR020128 NCRR NIH HHS
• K08 DK103983 NIDDK NIH HHS
• R01 HL095149 NHLBI NIH HHS
• National Institute of Diabetes and Digestive and Kidney Diseases
• National Institutes of Health
• National Center for Research Resources Construction
• National Center for Advancing Translational Sciences
• Gilead Sciences

• cardiovascular disease
• highly active antiretroviral therapy
• platelets

• Adult
• Antiretroviral Therapy, Highly Active
• Blood Platelets/physiology
• Cardiovascular Diseases/epidemiology
• HIV Infections/complications
• HIV Infections/drug therapy
• Humans
• Research Design
• Risk Assessment
• Risk Factors
• Systematic Reviews as Topic
• Meta-Analysis as Topic

• Africa
• HIV services
• NAFLD
• cardiovascular
• diabetes mellitus
• dyslipidemia
• metabolic clinic
• metabolic syndrome