Important note: Information in this article was accurate in 2008. The state of the art may have changed since the publication date.
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New Vision (Kampala) - December 14, 2008
Conan Businge
Figures from the diabetes foundation indicate that the disease is increasing, especially in the developing world. What is more worrying, however, is the fact that anti-retroviral drugs, used in the treatment of AIDS patients, are closely linked to the increase in diabetes cases.
Prevalence of HIV/AIDs
At the end of 2007, women accounted for 50% of all adults living with HIV worldwide, and for 59% in sub-Saharan Africa. According to the World Health Organisation, more than one million HIV-positive people receive anti-retroviral therapy in Sub-Saharan Africa.
Dr. Kaushik Ramaiya, a consultant physician from Tanzania, says: "The longterm use of anti-retroviral drugs (ARVs) leads to diabetes." Ramaiya says ARVs increase the levels of insulin and cholesterol (a waxy substance produced by the liver and found in certain foods) in the blood. HIV-infected patients on highly active anti-retroviral therapy have significantly increased blood fat levels.
According to health experts, the anti-retroviral drugs increase fat levels in the blood and in the waist and stomach area. The drugs can also cause fat on the arms, legs, face and buttocks to move to the stomach. A research report from Australia's Garvan Institute indicates that excess weight around the waist can increase a person's chances of developing cardiovascular disorders including diabetes.
The lead author of the study, which was published in the journal Obesity, Katherine Samaras, said the findings indicate that older anti-retrovirals can give many HIV-positive patients the same level of diabetes and heart disease risk seen in obese people with inactive lifestyles.
The study found that anti-retrovirals could cause fat cells to create molecules which promote diseases like diabetes. Samaras adds: "When fat cells are healthy, they help maintain our metabolism, but if they become too large or are affected by drugs, such as HIV medications, they can produce numerous chemicals linked to heart disease and diabetes.
The chairman of the Uganda Diabetes Association, Prof. Andrew Otim, says even without ARVs, being infected with HIV can damage the pancreas, leading to diabetes. "Once the pancreas is attacked and its cells are destroyed, one easily gets diabetes." The pancreas secretes insulin, which is of fundamental importance in the handling of glucose. If the pancreas is not functioning properly, diabetes may develop.
Otim also says other diseases like tuberculosis and cancer also affect the pancreas. He adds that: "Stress that may envelope the patient on knowing that he or she is HIV-positive can also unmask diabetes."
The bad news is, newer classes of drugs which do not cause fat redistribution, are too expensive for most people, researchers say. Samaras explains : "There are drugs on the market which do not have these side effects though they are too expensive for most people. The primary concern is to optimise viral suppression, that is, reduce the virus load in the body, to minimise its effects." She adds that physicians should ensure that their HIV-positive patients are regularly screened for diabetes.
Diabetes cases rising
The death rates from diabetes are predicted to rise by 25% over the next decade. Seven out of ten countries with the highest number of people living with diabetes are in the developing world. It is increasing faster in the world's developing economies than in developed countries.
Diabetes is responsible for over one million amputations each year, a large percentage of cataracts and at least 5% of worldwide blindness is due to diabetic retinal disease.
The leading cause of diabetes was once thought to be heredity (passed on from parents to children). It is still a major factor but the leading cause of today is being overweight.
Diabetes often goes undiagnosed because many of its symptoms seem harmless. Recent studies done by several diabetes associations show that the early detection of diabetes symptoms and treatment can decrease the chance of developing complications of the disease. Symptoms include frequent urination, excessive thirst, extreme urine, unusual weight, and increased fatigue. Others are irritability and a blurry vision.
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