Health & Fitness
Convergence of HIV/AIDS and the ‘silent killer,’ diabetes, in South Africa
On the eve of a general election in South Africa, it may be worthwhile to contemplate the health of its citizens. The trends of increased new HIV infections and diabetes are troubling and will need to be addressed.
There are more than 6.1 (prevalence = 17.9%) and 2.6 million people (comparative prevalence = 9.27%) who are currently living with HIV and diabetes, respectively, in South Africa (1,2). With more than 400, 000 new HIV infections occurring in 2012, this country ranks first globally in HIV incidence (3). In addition, the growing number of adults in Africa with diabetes is expected to almost double from 408 million in 2013 to 776 million by 2035 – a trend that will likely also affect South Africa (listed among the top 5 African countries with diabetes) (1).
There are clinical associations between HIV/AIDS and diabetes. Consistent, effective care of patients with anti-retroviral therapies (ARTs) translates into HIV/AIDS patients living longer and becoming prone to other chronic conditions such as diabetes. Moreover, patients who receive ARTs are more likely to develop diabetes, as some of the drugs cause glucose intolerance as one of the side effects, according to Dr. Anil Kapur of the World Diabetes Federation. Current South African guidelines for the use of ARTs, drug classes used in different combinations, and some of the other adverse events associated with these classes (e.g. metabolic complications such as dyslipidemia) are summarized here.
The increasing use of highly-effective ARTs – a necessity to control the sub-Saharan African HIV/AIDS epidemic – will contribute to the increased prevalence of diabetes (4). The US Department of Veterans Affairs has summarized key points for the management of diabetes in HIV patients, including behavioral modification, glycemic control as per specified criteria, patient education, self-monitoring, and switching ARTs. Innovative, affordable healthcare delivery systems will be required to ensure appropriate and sustained management of both diseases (4).
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References
1. International Diabetes Federation. IDF Diabetes Atlas, 6th edn. Brussels, Belgium: International Diabetes Federation, 2013: Regional overviews. https://www.idf.org/sites/default/files/DA6_Regional_factsheets_0.pdf Accessed May, 2014.
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2. UNAIDS. HIV and AIDS (2012 estimates). 2012; http://www.unaids.org/en/regionscountries/countries/southafrica/ Accessed May, 2014.
3. Human Sciences Research Council. South African National HIV Prevalence, Incidence and Behaviour Survey, 2012. 2014; http://www.hsrc.ac.za/uploads/pageContent/4565/SABSSM%20IV%20LEO%20final.pdf. Accessed May, 2014.
4. van Vugt M, Schellekens O, Reiss P, Hamers R, Rinke de Wit T. Diabetes and HIV/AIDS in sub-Saharan Africa: the need for sustainable healthcare systems. Diabetes Voice. 2007;52(3):23-26.
