Association between HIV infection and type 2 diabetes mellitus: global incidence, prevalence, and risk factors - a systematic review and meta-analysis

Abstract

Introduction: People living with HIV (PLHIV) are at an increased risk of type 2 diabetes mellitus (T2DM) due to aging, lifestyle, and antiretroviral therapy-related factors. This systematic review and meta-analysis estimated the pooled incidence, prevalence, and risk factors for T2DM among PLHIV globally, focusing on older populations.

Methods: This systematic review and meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We conducted a comprehensive literature search in PubMed, Embase, Web of Science, and Scopus for English-language articles published by December 25, 2024. The I² index and Cochrane’s Q statistic were also used to assess study heterogeneity. A random effects model was used to compute the pooled measure of association with 95% confidence intervals. Moreover, the Egger test was used to assess publication bias.

Result: After screening, 112 studies were selected for analysis. These included 491,367 PLHIV, of whom 39,021 had diabetes. Among them, 5,363 PLHIV were over 50 years old with diabetes. One hundred and twelve of these studies have assessed the prevalence of diabetes among people with HIV, while ten studies have reported both the incidence and prevalence of diabetes in this group. This analysis demonstrated an association between HIV and increased odds of T2DM (OR: 1.61, 95% CI: 1.09–2.38). Additionally, there was a significant association between T2DM and being over 50 years (OR: 3.35, 95% CI: 2.52–4.44), having a family history of DM (OR: 2.30, 95% CI: 1.58–3.73), a body mass index (BMI) greater than 25 (OR:2.43, 95% CI: 1.58–3.73), and having hypertension (OR: 1.10, 95% CI: 1.39–3.19) among PLHIV. Furthermore, the prevalence of T2DM among PLHIV was found to be 9% (95% CI: 8%–10%), and it was 11% (95% CI: 9%-13%)among PLHIV aged 50 and older. Additionally, a higher prevalence of T2DM was observed in PLHIV who use NRTIs14% (95% CI: 2%-28%), those who have been on antiretroviral therapy for more than 10 years 15% (95% CI: 6%-26%), and those diagnosed with advanced HIV disease 8% (95% CI: 4%-14%).

Conclusion: This analysis highlights a significant association between HIV and increased T2DM risk, with age, family history of DM, high BMI, and hypertension as key factors. Comprehensive diabetes screening and preventative interventions, including lifestyle modifications such as personalized nutritional guidance, promotion of regular physical exercise, and consistent glucose monitoring, are crucial for improving outcomes in PLHIV.

Clinical trial: Not applicable.

Supplementary Information: The online version contains supplementary material available at 10.1186/s12879-025-12222-5.

Keywords: Global; HIV infection; Incidence; Meta-analysis; Prevalence; Type 2 diabetes mellitus.

Fig. 1

A flow chart depicting the stages of retrieving articles and checking eligibility criteria for meta-analysis to assess the impact of HIV on incidence and prevalence of diabetes

Fig. 2

Incidence rates, odds ratios, and associated odds ratios for diabetes among people living with HIV

Fig. 3

Odds ratios associated with diabetes mellitus among people living with HIV

Fig. 4

Prevalence of diabetes mellitus among people living with HIV

Fig. 5

Funnel plot of included studies related to diabetes mellitus among people living with HIV

Fig. 6

Results of sensitivity analysis for the odds ratio for diabetes risk among people living with HIV aged over 50 years