The Prevalence of Diabetes Mellitus among People Living with HIV/AIDS Receiving Anti-Retroviral Therapy in Chiradzulu District, Malawi: A Cross – Sectional Study

Download Article

DOI: 10.21522/TIJPH.2013.07.04.Art021

Authors : Beatrice Chitsa


The study was conducted to determine the prevalence of diabetes and its associated factors in people living with HIV/AIDS receiving Anti-Retroviral Therapy (ART) in Chiradzulu district, Malawi. A hospital-based cross-sectional study was conducted between April and October 2016. Using systematic random sampling, secondary data from patients’ records registered at ART and diabetes clinics were extracted. Categorical variables were compared using Chi-square test, independent samples test was used to compare means and multiple logistic regressions were used to calculate adjusted odds ratios for the effect of potential risk factors on diabetes. Out of 440 participants (10%) were diabetic. After adjusting for other variables, age, BMI, DM family history, hypertension and WHO stage 2 remained significant predictors of diabetes p<0.05. In addition, use of TDF/3TC/ATV/r was also a strong predictor of diabetes mellitus and the adjusted odds ratio (AOR) for TDF/3TC/ATV/r users was 6.08, CI [31.82], P=0.032).

The study concluded that diabetes mellitus is a big concern for people on treatment living with HIV/AIDS. Therefore, the study recommends that HIV/ART exposed patients should be checked for DM regardless of the absence or presence of the common diabetes’ risk factors. For the sake of planning and implementing targeted routine monitoring, diabetes risk factors need proper identification.

Keywords: HIV/AIDS, diabetes mellitus, Antiretroviral therapy, combined antiretroviral therapy, Body mass index, Atazanavir/ ritonavir.


[1].   Allain, T. & E. Bothmer, (2011) Tip of the iceberg: comments and interviews [Internet]. (November 2011) Available AT: (accessed on: 05/01/16).

[2].   Amorosa, V., Synnestvedt, M., Gross, R., Friedman, H., McGregor, R.R., Gudonis, D., …I. Tebas, P. (2005) ‘A Tale of 2 Epidemics: The Intersection Between Obesity and HIV Infection in Philadelphia’. J Acquir Immune Defic Syndr 2005; 39:557–561). Available at:  file:///C:/Users/HP/Downloads/A_Tale_of_2_Epidemics__The_Intersection_Between.8.pdf (accessed on: 12/06/16

[3].   Brown, T. T., Cole, S. R., Li, X. L., Kingsley, L. A., Palella, F. J., Riddler, S. A. … Dobs, A. S. (2005), ‘Antiretroviral Therapy and the Prevalence and Incidence of Diabetes Mellitus in the Multicenter AIDS Cohort Study’. Arch Intern Med. 165 (10) :1179-1184Available at: (accessed on: 25/01/16).

[4].   Butt A. A., McGinnis., M. C. Rogriguez-Barradas, M. C., Crystal, S., Simberkoff, M., M. B. Goetz, M. B., … Justice, A. C. (2009). ‘HIV Infection and the risk of diabetes’. AIDS. 23(10): 1227–1234. doi:10.1097/QAD.0b013e32832bd7af. (accessed on: 13/08/16)

[5].   Calza, L., Masetti, G., Piergentili, B., Tripani, F., Cascavilla, A., Manfredi, R., … Viale, P. (2011) ‘Prevalence of diabetes mellitus, hyperinsulineamia and metabolic syndrome among 755 adult patients with HIV-1 infection. Int J STD AIDS, 22(1) PP.43 – 45. Available at: (accessed on: 28/03/16).

[6].   Calza, L., Manfredi, R., & Chiodo, F. (2003), Dislipidemia associated with antiretroviral therapy in HIV-infected patients. Journal of antimicrobial chemotherapy 53 (1) pp. 10 – 14 DOI: 10.1093/jac/dkh013. (accessed 0n: 05/09/16)

[7].   Capeau, J., Bouteloup, V., Katlamac, C., Bastard, J. P., Guiyedid, V., Salmon-Ceron, D., … Chêne, G. (2011) ‘Ten-year diabetes incidence in 1046 HIV infected patients started on a combination antiretroviral treatment’. AIDS 23 (3): 303-314. Available at: file:///C:/Users/HP/Downloads/Ten_year_diabetes_incidence_in_1046_HIV_infected.6%20(1).pdf (accessed on: 28/03/16).

[8].   Chukwuanukwu, R. C., Manafa, P. O., Ugwu, E.E., Onyenekwe, C. C. Oluboyo, A. O., I. P. Ezeugwunne, I. P., … Ogenyi, S. I. (2013) ‘The Incidence of Diabetes Mellitus among Human Immunodeficiency Virus (HIV) Positive Patients on Therapy in Nnewi’. Journal of Nursing and Health Science 2 (3): pp. 37 – 40. Available at: (accessed on: 27/03/16).

[9].   Cohen, D. B., Allain, T. J., Glover, S., Chimbayo, D., Dzamalala,H., H. W. C. Hofland, H. W. C., … Zijstra, E. E. (2010), ‘A Survey of the Management, control and complications of diabetes in patients attending a diabetes clinic in Blantyre, Malawi, an Area of High HIV prevalence’. Am J Trop Med Hyg, 83 (3) pp. 575 – 581. Available at: (accessed on: 15/01/16).

[10].  De Wit, S., Sabin, C. A., Weber, R., Worm, S. W., Reiss, P., Cazanave, C., … Phillips, A. (2009)Incidence and Risk Factors for New-Onset Diabetes in HIV Infected Patients: The Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) Study’. Diabetes Care. 2008 June; 31(6): 1224–1229. doi:10.2337/dc07-2013. (accessed on: 31/01/16).

[11].  Diouf, A., Cournil, A., Ba-Fall, K., Ngom-Gueye, N. F., Eymard-Duvernay, S., Ndiaye, I., … Sow, P. S. (2014) ‘Diabetes and Hypertension among patients receiving Antiretroviral treatment since 1998 in Senegal: Prevalence and associated factors. International Schlarly Research Network (ISRN) AIDS. Doi:10.5402/2012/621565. (accessed on: 13/01/15).

[12].  Florescu, D., & Kotler, D. P. (2009) Insulin resistance, glucose intolerance and diabetes mellitus in HIV-infected patients. Review, (12) pp. 149 – 162. Available at:

[13].  Galli, L., Salpietro,S., Pellicciotta, G., Galliani, A., Piatti, P., Hasson, H., …Castagna, A. (2012) ‘Risk of type 2 diabetes among HIV-infected and health subjects in Italy, (Abstract) Eur J Epidemiol 27 (8) Available at: (accessed on: 29/03/16).

[14].  Hasse, B., Ledergerber, B., Furrez, H., Battegay, M., Hirschel, B., Cavassini, M., … Weber, R. (2011). ‘Morbidity and aging in HIV – infected persons. The Swiss HIV cohort study’. Clinical infectious diseases, 53 (11) pp. 1130 – 1139. Available at: (accessed on: 15/01/16).

[15].  Hughes, C. A., Cashin, R. P., Eurich, D. T., Houston, S. (2005). Risk factorsfor new-onset diabetes mellitus in patients receiving protease inhibitor therapy. Can J Infect Dis Med Microbiol 16 (4) 230 – 232. Available at: (accessed on 08/09/16).

[16].  Jain, M. K., Aragaki, C., Fischbach, L., Gibson, S., Apora, R., May, L., … Lee, W. M. (2007) ‘Hepatitis C is associated with type 2 diabetes mellitus in HI – infected patients without traditional risk factors’ HIV Medicine; 8 (8) pp. 491 – 497. Available at: (accessed on: 28/07/16).

[17].  Jevtović D. J., Dragović, G., Salemović, D., Ranin, J., Djurković-Djaković, O. (2009) The metabolic syndrome, an epidemic among HIV-infected patients on HAART. (Abstract), Biomedical and Pharmacotherapy; 63(5) pp 337 – 342. Available at: (accessed on: 10/07/16).

[18].  Jung, O., Bickel, M., Ditting, T., Rickerts, V., Welk, T., Helm, E. B., … Geiger, H. (2004) ‘Hypertension in HIV-1-infected patients and its impact on renal and cardiovascular integrity’. Nephrol Dial Transplant 19 (9) pp. 2250–2258 DOI: 10.1093/ndt/gfh393 (accessed on: 28/08/16).

[19].  Justman, J. E., Benning, L., Danoff, A., Minkoff, H., Levine, A., Greenblett, R. M., … Anastos, K. (2012), ‘Protease Inhibitor use and the incidence of diabetes mellitus in a Large cohort of HIV- Infected women’. Journal of Acquired Immune Deficiency Syndromes, 32: pp. 298 – 302. Available at: (accessed on: 02/02/16 )

[20].  Kagaruki, G. B., Mayige, M. T., Ngadaya, E. S., Kimaro, G. D., Kalinga, A. K., Kilale, A. M., … Mfinanga, S. G., (2014) ‘Magnitude and risk factors of non-communicable diseases among people living with HIV in Tanzania: A cross sectional study from Mbeya and Dae es Salaam regions’. BMC Public Health 14 (904) DOI: 10.1186/1471-2458-14-904.

[21].  Kalra, S., Karla, B., Agrawal, N., Unnikrishnan, A. D. (2011), ‘Understanding diabetes in patients with HIV/AIDS’, Dabetology & Metabolic Syndrome, 3 (2). Available at: (accessed on 15/01/16).

[22].  Ledergerberg, B., Furrer, H., Rickenback, M., Lehmann, R., Elzi, L., Hirschel, B., … Weber, R. (2007) ‘Factors associated with type 2 Diabetes Mellitus in HIV-Infected participants in the Swiss HIV Cohort Study’. HIV/AIDS, 45 PP. 111 – 119. Available at: (accessed on: 26/03/16).

[23].  Malawi National AIDS Commission (NAC) (2015) Malawi AIDS Response Progress Report. Available at: (accessed on: 07/04/16).

[24].  Medecins SANS Fronteres & UNAIDS, (2012) Delivering Antireviral Therapy in the Community: Experience from four countries in Southern Africa. Available at: (accessed on: 17/02/16).

[25].  Malawi Ministry of Health (2011) Clinical management of HIV in children and adult – Malawi integrated guidelines for providing HIV services. Available at: (accessed on: 01/05/16).

[26].  Malawi Ministry of Health & World Health Organization, (2010) Malawi National Steps Surey for chronic Non-communicable diseases and their risk factors – Final report. Available at: (ccessed on: 12/01/16).

[27].  Mohammed, A. E., T. Y. Shenkute, T. Y., Gebisa, W. C. (2015) ‘Diabetes mellitus and risk factors in huma N immunodeficiency virus-infected individuals at Jimma University Specialized Hospital, Southwest Ethiopia’. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 8, pp. 197 – 206. Available at: (accessed on: 31/01/16).

[28].  Moyo, D., Tanthuma, G., Mushisha, O., Kwadiba, G., Chikuse, F. (2013) ‘Diabetes mellitus in HIV – infected patients receiving Antiretroviral therapy. South African Medical Journal, 104(1): pp.37-39. DOI:10.7196/SAMJ.6792 (accessed on: 24/01/16).

[29].  Msyamboza KP, B. Ngwira, T. Dzowela, C. Mvula, D. Kathyola, A.D. Harries, A. D., … Bowie, C. (2011) ‘The burden of selected chronic non-communicable diseases and their risk factors in Malawi: nationwide STEPS survey. PLoS ONE 6(5): e20316. doi:10.1371/journal.pone.0020316. (accessed on: 15/01/16).

[30].  Msyamboza, K. P., Mvula, C. J., Kathyola, D. (2014), ‘Prevalence and correlates of diabetes mellitus in Malawi: Population- ased national NCD STEPS Survey’. BMC Endocrine Disorders, 14 (41). Available at: (accessed on: 15/01/16).

[31].  Muula, A. S. & Kataika, E. (2008) Assessment of Equity in the uptake of anti-retrovirals in Malawi. Equinet Discussion Paper 58. Available at: (accessed on: 28/08/16).

[32].  NigatuHaregu, T, Oldenburg, B., Setswe, G., Elliott, J. (2013), ‘Magnitude of Diabetes Comorbidity among People Living with HIV: A Systematic RevieW’, International Journal of Diabetes Research, 1(5): 81-86 DOI: 10.5923/j.diabetes.20120105.02. (accessed on: 01/02/16).

[33].  Ritchter, A. Pladevall, M., Manjunath, R., Lafata, J. E., Xi, H., Sampkins, J., …Irish, W. (2005) ‘Patient characteristics and costs associated with dyslipidaemia and related conditions in HIV-infected patients: a retrospective cohort study’. HIV medicine 6 pp. 79 – 90. Available at: (accessed on: 03/09/16).

[34].  Sachithananthan, V., Loha, E., & Gose, M. (2013) ‘Prevalence of diabetes mellitus, hypertension and lipodystrophyin HAART receiving HIV patients in Southern Ethiopia’. International STD Research and Reviews. 1: pp. 1- 11. Available at: file:///C:/Users/HP/Downloads/1357192497-Sachithananthan_112013ISRR1897.pdf (accessed on: 28/03/16).

[35].  Samarasinghe, Y. P., (2007), ‘HIV and diabetes’. Primary care diabetes, 1 pp. 99–101. Available at: (accessed on: 26/01/16).

[36].  Samaras, K., Wand, H., Law, M., Emery, S., Cooper, D., Carr, A. (2007) ‘Prevalence of metabolic syndrome in HIV- Infected patients receiving Highly Active Antiretroviral Therapy using International Diabetes Foundation and Adult treatment Panel 111 Criteria’. Diabetes Care, 30 (1) pp. 113 – 119. Available at: (accessed on: 26/03/16).

[37].  Samaras, K. (2008) ‘Metabolic consequences and therapeutic options in highly active antiretroviral therapy in human immunodeficiency virus-1 infection. Journal of Antimicrobial Chemotherapy; 61 pp.238-45. Available at:

[38].  Tien, P. C., M. F. Schneider, C. Cox, R. Karim, M. Cohen, Sharma, M. Young, & M. J. Glesby, (2012), ‘Association of HIV infection with Incident Diabetes Mellitus: Impact of using Hemoglobin A1C as a Criterion for Diabetes’. J Acquir Immune Defic Syndr. 2012 November 1; 61(3): 334–340. doi:10.1097/QAI.0b013e31826bfc32.

[39].  Van Vugt, M., R. Hamers, O. Schellekens, T. R. de Wit, & P. Reiss, (2007) ‘Diabetes and HIV/AIDS in sub- Saharan Africa: the need for sustainable healthcare systems. Diabetes Voice, 52 (3) pp. 23 -26. Available at: (accessed on: 15/01/16).

[40].  World Health Organization, (2016) World Health Organization Diabetes Country Profile for Malawi Available at: (accessed on: 29/08/18).

[41].  Young, F., J. A. Critchley, L. K. Johnstone, & N. C. Unwin, (2009) ‘A review of commobidity between infectious and chronic disease in Sub Saharan Africa: TB and Diabetes Mellitus, HIV and Metabolic Syndrome, and the impact of globalization’. Globalization and Health 5 (9). Available at: (accessed on: 27/03/16.