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Diabetes And Systemic Complications in 191
Immune Deficiency Syndrome

immune diabetes in adults occurs much more often extra-intestinal sites, including endocrine manifesta-
than it was previously thought . Chronic autoimmune tions. Of these, two endocrine disorders are partic-
process leading to the destruction of the B cells of ularly prominent, thyroiditis, especially, but not ex-
pancreatic islets is a cellular response and observed clusively, in adults, and insulin-dependent diabetes,
in type 1 diabetes antibodies associated with humoral particularly, but also not exclusively, in children.
response is a marker of ongoing autoimmune de-
struction process. The presence of antibodies can de- T2DM in patients with HIV
fine a person at risk of developing type 1 diabetes as Findings from the Multicentre AIDS Cohort Study
early as during the pre-clinical stage of disease . The (MACS) showed a T2DM incidence of 47 in HIV-in-
prevalence of anti-GAD antibodies in type 1 diabetes fected white males who were on cART versus 17 in
was found in 80-90% patients with newly diagnosed those who were cART naïve; however, this study
diabetes and 70 -80% in patients with the preclinical used only a single increased fasting plasma glucose
diabetes is present preceded by several years of be- as their diagnostic criteria. Nigatu et al, in 2013 con-
fore clinical manifestation of the disease 1
ducted a systematic review looking at incidence of
various comorbidities, including T2DM, with HIV in-
Celiac disease (CD) fection, and found a combined T2DM incidence rate
Celiac disease (CD) is an immune-mediated small of 6 (with a range of 4.2–36) in a sample of 44 484
intestinal disorder that occurs in genetically suscep- individuals. In the studies included in their system-
tible people and is characterized by an intolerance to atic review, ART exposure increased incidence rates
gluten-containing proteins found in wheat, rye and when compared with ART-naïve patients. Therefore,
barley grains. Often, symptomatic persons present although incidence does not seem to be higher in
with diarrhea, nutrient malabsorption and weight loss patients with HIV infection in Africa compared with a
associated with a mucosal inflammatory process in normal ageing population in Africa; T2DM incidence
the proximal small intestine. Mucosal architecture in HIV-infected people in Africa does appear to be
may be severely altered in the duodenum and, with higher than rates reported internationally for patients
increasing severity, may extend for variable distanc- with HIV infection, and those reported for a healthy
es into more distal jejunum and ileum. It may be that American population 3
the severity of the individual inflammatory response, Incidence rates of DM as high as 5–14 cases per
the timing of its appearance as well as the extent 1000 person years of follow up have been report-
and localization within the small intestine are genet- ed in HIV/AIDS patients after initiation of HAART .
ically-programmed
These alarming rates draw particular attention be-
cause multiple high-risk conditions and cardiovas-
cular disease have been found to have worsened
clinical outcomes in HIV/AIDS patients having DM as
co-morbidity . Hence early identification of patients
at risk of DM is of utmost importance. Even though
we found no study that quantified and compared the
risk of having diabetes in these patients using the
DRS, a Norwegian study had results similar to ours
In recent years, the disorder has become increasing- using the Framingham risk score. This study found a
ly appreciated even without significant gastrointes- higher Framingham risk score and mean estimated
tinal symptoms, being documented in up to 2% of risk of cardiovascular heart disease in patients on
the serologically-studied populations, and perhaps, HAART than in HAART-naïve patients, even though
higher in referred patients using endoscopic screen- the Framingham risk score has been reported to be
ing biopsies . The disorder is not only common, but a less accurate predictor of DM than the metabolic
2
4
has been increasingly recognized as a phenotypically syndrome .
heterogeneous disorder. Increased clinician aware- However, in Italy, investigators reported a higher
ness as well as widespread use of serological testing prevalence of 4.1% among ART-experienced patients
for case-finding have been important factors in the , and in China 10.5% of ART-naive patients had T2DM.
emergence of this disorder in the scientific commu- Patients in Italy were older (46 vs 37 years) and had
nity.. significantly higher CD4 counts than patients in our
+
study (538 vs 206 cells/μL), while the prevalence of
As a result, clinical features attributed to celiac dis-
ease or its complications have been noted in other diabetes in a Chinese population was higher than

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