By Dr. Sharif Mutabazi–Director Microcure Medical Centre
BUSHENYI: About 18% of persons living with HIV have type2 diabetes with males more affected at 23.4% according to published literature in Uganda.
Whereas there are many types of diabetes, type 2 is the most common among PLHIV. Having HIV causes unique risk factors for acquiring type 2 diabetes including;
- Taking HIV medicines like Kaletra (lipinavirtritonavir),doolutegravir.
- Having lipodystrophy (abnormal fat distribution with abdominal obesity a buffalo hump)
- Having HIV related inflammation which affects gut bacteria (gut micro biome defect) and pancreatitis.
- Poor adherence increases the risk
People living with HIV need regular screening for diabetes including detection for pre diabetes (early diabetes disease). Any person living with HIV who experience increased thirst, buzzed vision, numbness in the hands and feet should test for diabetes.
Having HIV and diabetes increases risk of complication including diabetes kidney disease, heart complications, and erectile dysfunction.
Taking your ARVs to suppress viral load and appropriate diabetes medications lower the above risks.
Whereas science has made progress towards better treatment for diabetes, the critical medicines are still unaffordable especially the GLP1 Receptor agents like Trulicity and Monjauro with one pen costing about 500,000 UGX and 2.5 Million UGX respectively.
The GLP1 agents confer about risk reduction among persons with diabetes with or without HIV by reducing risk of stroke, kidney failure and heart diseases.
The agents also reduce body weight thereby improving insulin resistance. The Government needs to focus on these life saving drugs and put them on the essential drug list.
In addition, screening of diabetes complications is only possible at Regional Referral Hospitals and private healthcare facilities because most District hospitals and Health Centre IVs cannot check for Urine Microalbumin (early surrogate maker for diabetic kidney disease), HBA1c(gold standard for monitoring diabetes control) and fundus scan for testing for diabetes eye disease.
As a result persons living with HIV and diabetes are dying from preventable causes.
The recent cut in HIV funding has added an insult to an injury but requires careful integration of healthcare systems for management of NCDs but also calls for significant investment in human resource training, drugs and facilities.
With the strides we have made in the fight against HIV, let’s not forget that persons living with HIV are now dying of diabetes, hypertension and heart disease.
End.
