HIV/AIDS has remained a huge burden. It is still affecting large population of people globally
with mortality of over 35 million people. South Africa is the most affected country. Substantial
progress has been made in HIV antiretroviral therapy which is now capable of suppressing viral
replication and prevent transmission. Great efforts and significant successes have been recorded
in the fight against HIV/AIDS especially in South Africa. With effective medications, PLWH now
have increased longevity, this makes them susceptible to chronic diseases like diabetes. The burden
of diabetes is also high in KwaZulu-Natal, which also comes with its attendant complications.
Despite the progress made, the scourge of HIV/AIDS and diabetes still persists. Hence this study
aimed to evaluate the management of HIV/AIDS and diabetes as a comorbid condition, and to
determine factors that contribute to patient outcomes.
The study was conducted in 4 HIV clinics attached to Public Sector Hospitals in the eThekwini
Metro of Kwazulu-Natal (KZN) South Africa after obtaining ethical approval. A total of 1,203
adult, non-pregnant patients living with HIV and were receiving antiretroviral therapy for at least
6 months between 2005 and 2019 were randomly selected and recruited in the study after obtaining
written consent from them. Data was collected using questionnaire and from patient chart. The
statistical package for social sciences (SPSS) software version 26 was used to analyze the data
using descriptive statistics, Chi square and logistic regression. Results were presented, discussion
and conclusion were made as appropriate.
There were 770 (64%) females and 405 (33.7%) males included in this study, with 29 to 48 years
as the largest age group (60.2%). Clinicians prescribed the recommended add regimens in all cases.
TDF + FTC + EFV was the most recommended regimen at 65%. On the average 43.85% of HIV
patients were initiated on ART at CD4 count <200 cells/µL. Male gender and baseline CD4 count
were the predictors of ART regimen changes.
It was found that 40.8% of PLWH on ART were virally suppressed. The probability of achieving
viral suppression was significantly less in younger patients, the less educated and those with
baseline CD4 cells count less than 200cells/µL, while the likelihood of achieving viral suppression
was about 4 times higher for those that received encouragement from family to adhere to ART.
The prevalence of immunologic failure among PLWH on ART was 8.6 % (CD4 cell count <200
cells/µL). CD4 cells count outcome was statistically significantly associated with gender, poor
adherence to ART and baseline CD4 cells count. The probability of immunologic decline for those
who did not strictly adhere to ART was more than 3 folds higher than those who adhered to ART;
and the probability of immunologic failure was more than 8 folds higher for those who had baseline
CD4 cells <200 cells/µL than those who had baseline CD4 cells ≥200 cells/µL.
The prevalence of diabetes among PLWH on ART was 9%. Over 47% of those who had diabetes,
had uncontrolled blood sugar, with a mean fasting blood sugar (FBS) of 11.7 mmol/L. The
predictors of diabetes among PLWH on ART were, gender and age. Male PLWH had 65% less
chances of having diabetes and those who were between the ages of 18 and 48 years were 88%
less probable to have diabetes compared to those who were older than 48 years.
Conclusion and Recommendations
Clinicians adhered to the national treatment guidelines, but significant percentage of the patients
were initiated on ART late resulting in poor outcome. Those who test positive for HIV should be
informed on the benefits of initiating ART early, the possible consequence of late initiation of
ART and Clinicians must ensure everyone who needs ART is offered one without delay.
The prevalence of immunologic failure was 8.6%. Predictors to immunologic failure were nonadherence and late initiation of ART (CD4 cells <200 cells/µL).
Prevalence of viral suppression was low (40.8%). The chances of virological failure was higher
among younger, less educated, patients who started ART late (<200cells/µL) and patients who
received encouragement from family to adhere to ART. Young PLWH should be regularly
counselled on the benefits of adherence to ART, those that are not educated should be taught in
languages they best understand, and pictorial illustrations should be used for counselling and
family members should be involved in the follow up and encouragement of patients. That should
be done with the permission of patients.
The prevalence of diabetes among PLWH was high (9%) and 47% of these did not have glyacemic
control (mean FBS was 11.7 mmol/L). The predictors were male gender and older age. Those who
test positive to HIV should also be screened for diabetes before commencement of ART and
treatment for diabetes should be initiated as ART is initiated and blood sugar should be monitored
regularly to ensure glycaemic control, which is essential for the prevention of diabetic