Morbidity from antiretroviral metabolic effects in Africa: The Mama Study
type: CreativeWork
description: Introduction: Combination antiretroviral therapy (ART) has considerably reduced both the morbidity and mortality of Human Immunodeficiency Virus (HIV) infection and its associated complications, thus effectively transforming a fatal disease into a manageable chronic condition. However, the chronic use of ART has been accompanied by the emergence of adverse metabolic abnormalities in HIV-infected patients, including dysglycaemia. There is, however, a paucity of data from sub-Saharan Africa on the incidence and risk factors associated with new onset diabetes mellitus in the HIV-infected population. Furthermore, efavirenz is the preferred nonnucleoside reverse transcriptase inhibitor (NNRTI) in first-line antiretroviral therapy (ART) regimens in low- and middle-income countries, where the prevalence of diabetes is increasing. Randomized control trials have shown mild increases in plasma glucose in participants in the efavirenz arms, but no association has been reported with overt diabetes. This study explores the risk factors and incidence of diabetes, and in particular the association between efavirenz exposure and diabetes, in a large Southern African cohort commencing NNRTI-based first-line ART. Subjects and Methods: The study cohort included HIV-infected adults commencing NNRTI-based ART in a private sector HIV disease management programme from January 2002 to December 2011. Incident diabetes was identified by the initiation of diabetes treatment. Patients with prevalent diabetes were excluded. The incidence of diabetes in patients receiving efavirenz versus nevirapine containing regimens was compared with a Kaplan-Meier plot and a log-rank test. The association of efavirenz exposure with the hazard of developing diabetes was modelled using a multivariate Cox-proportional hazards model. The following variables were adjusted for in the regression model: age, sex, baseline BMI, baseline CD4, baseline viral load, exposure to diabetogenic drugs, and nucleoside reverse …
abstract: Introduction: Combination antiretroviral therapy (ART) has considerably reduced both the morbidity and mortality of Human Immunodeficiency Virus (HIV) infection and its associated complications, thus effectively transforming a fatal disease into a manageable chronic condition. However, the chronic use of ART has been accompanied by the emergence of adverse metabolic abnormalities in HIV-infected patients, including dysglycaemia. There is, however, a paucity of data from sub-Saharan Africa on the incidence and risk factors associated with new onset diabetes mellitus in the HIV-infected population. Furthermore, efavirenz is the preferred nonnucleoside reverse transcriptase inhibitor (NNRTI) in first-line antiretroviral therapy (ART) regimens in low- and middle-income countries, where the prevalence of diabetes is increasing. Randomized control trials have shown mild increases in plasma glucose in participants in the efavirenz arms, but no association has been reported with overt diabetes. This study explores the risk factors and incidence of diabetes, and in particular the association between efavirenz exposure and diabetes, in a large Southern African cohort commencing NNRTI-based first-line ART. Subjects and Methods: The study cohort included HIV-infected adults commencing NNRTI-based ART in a private sector HIV disease management programme from January 2002 to December 2011. Incident diabetes was identified by the initiation of diabetes treatment. Patients with prevalent diabetes were excluded. The incidence of diabetes in patients receiving efavirenz versus nevirapine containing regimens was compared with a Kaplan-Meier plot and a log-rank test. The association of efavirenz exposure with the hazard of developing diabetes was modelled using a multivariate Cox-proportional hazards model. The following variables were adjusted for in the regression model: age, sex, baseline BMI, baseline CD4, baseline viral load, exposure to diabetogenic drugs, and nucleoside reverse …
author: Karamchand, Sumanth
language: eng
date published: 2017
date modified: 2026-07-22T22:23:00Z
provider: University of Cape Town
publisher: Networked Digital Library of Theses and Dissertations
type: WebPage
source organization: Division of Clinical Pharmacology

PropertyValue
property ID: Handle
value: http://hdl.handle.net/11427/27345