• D Moyo, G Tanthuma, O Mushisha, G Kwadiba, F Chikuse, M S Cary, A P Steenhoff, and M J A Reid.
• Institute for Health Sciences, Gaborone, Botswana. michael.j.a.reid@gmail.com.
• S. Afr. Med. J. 2013 Oct 11; 104 (1): 37-9.

BackgroundThere is little in the literature on HIV and diabetes mellitus (DM) in sub-Saharan Africa.ObjectiveTo assess the characteristics of HIV and DM in patients receiving antiretroviral therapy (ART) in Botswana.MethodsA retrospective case-control study was conducted at 4 sites. Each HIV-infected patient with DM (n=48) was matched with 2 HIV-infected controls (n=108) by age (±2 years) and sex. Primary analysis was conditional logistic regression to estimate univariate odds and 95% confidence intervals (CIs) for each characteristic.ResultsThere was no significant association between co-morbid diseases, tuberculosis, hypertension or cancer and risk of diabetes. DM patients were more likely to have higher pre-ART weight (odds ratio (OR) 1.09; 95% CI 1.04 - 1.14). HIV-infected adults >70 kg were significantly more likely to have DM (OR 12.30; 95% CI 1.40 - 107.98). Participants receiving efavirenz (OR 4.58; 95% CI 1.44 - 14.57) or protease inhibitor therapy (OR 20.7; 95% CI 1.79 - 240.02) were more likely to have DM. Neither mean pre-ART CD4 cell count (OR 1.0; 95% CI 0.99 - 1.01) nor pre-ART viral load >100 000 copies/ml (OR 0.71; 95% CI 0.21 - 2.43) were associated with a significant risk of diabetes.ConclusionsThese findings suggest a complex interrelation among traditional host factors and treatment-related metabolic changes in the pathogenesis of DM inpatients receiving ART. Notably, pre-ART weight, particularly if >70 kg, is associated with the diagnosis of diabetes in HIV-infected patients in Botswana.

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