HIV clinical outcomes among people with HIV and diabetes mellitus in Kampala, Uganda; A matched retrospective cohort study

Abstract

Suppressive antiretroviral treatment (ART) has resulted into prolonged survival of people with HIV (PWH) in Sub-Saharan Africa (SSA) with resultant increase in the incidence of non-communicable diseases (NCD), such as diabetes mellitus (DM). However, there is a lack of data on the effect of DM on HIV-related outcomes among PWH in this setting. The study aimed to compare HIV clinical outcomes (viral load suppression, retention in care, hospitalization, tuberculosis, and mortality) between PWH with DM and those without at two large HIV clinics in Kampala, Uganda. We conducted a matched retrospective cohort study using secondary data of PWH with DM and PWH without DM from January 2020 to June 2022. We used descriptive statistics to compare baseline characteristics and a chi-square test to compare the outcomes between the HIV/DM and HIV/no DM groups. The cohort consisted of 243 PWH diagnosed with DM matched with 1221 PWH without DM. We analysed 1,469 participant records: 1,009 (68.7%) from Mulago ISS clinic and 460 (31.3%) from Kisenyi HC IV. Most study participants (63.6%) were female, and the mean age was 43 years (standard deviation [SD] 11) and 38 years (SD 10) for those with DM and without DM, respectively. PWH with DM had significantly higher odds of hospitalization (adjusted odds ratio [AOR] 4.94; 95% CI: 1.93-12.66; p = 0.001) and were less likely to be retained in care (AOR 0.12, 95% CI: 0.07-0.20 p = <0.001). There were no differences in viral load suppression, TB diagnosis, and mortality between the PWH with DM and those without DM. These findings underscore the need for integrated management approaches that address both HIV and DM to improve health outcomes for this population. Future research could also explore the causes of hospitalization and non-retention among PWH and DM.

Fig 1. Cohort analysis flow representation.