Diabetes, metabolic syndrome and dyslipidemia in people living with HIV in Africa: re-emerging challenges not to be forgotten

Nazik Elmalaika Husain,1 Sufian K Noor,2 Wadie M Elmadhoun,3 Ahmed O Almobarak,4 Heitham Awadalla,5 Clare L Woodward,6 Dushyant Mital,6 Mohamed H Ahmed7 1Department of Pathology, Faculty of Medicine and Health Sciences, Omdurman Islamic University, Khartoum, 2Department of Medicine, 3Department of Pathology, Faculty of Medicine and Health Sciences, Nile Valley University, Atbara, 4Department of Pathology, Faculty of Medicine, University of Medical Sciences and Technology, 5Department of Community Medicine, Faculty of Medicine, University of Khartoum, Khartoum, Sudan; 6Department of HIV and Genitourinary Medicine, Milton Keynes University Hospital, NHS Foundation Trust, Milton Keynes, UK; 7Department of Medicine and HIV Metabolic Clinic, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes, UK Background: The current challenge in managing people living with human immunodeficiency virus (PLWHIV) includes the identification and monitoring for comorbid health risks associated with HIV and its treatment and longer survival. Dyslipidemia, diabetes mellitus and metabolic syndrome are increasingly seen in PLWHIV. Objective: In this narrative review, we aimed to summarize the current knowledge about diabetes, dyslipidemia and metabolic syndrome in PLWHIV in Africa and also to discuss the challenges that patients as well as health authorities in Africa may face. Methods: PubMed and Google scholar published-English literatures concerning earlier mentioned entities regardless of time limit were critically reviewed. Results: The prevalence of metabolic disorders in HIV population in Africa was estimated to range from 2.1% to 26.5% for diabetes and 20.2% to 43.5% for pre-diabetes, 13% to 58% for metabolic syndrome and 13% to 70% for dyslipidemia. Conclusion: The management of metabolic disorders and cardiovascular disease risks related to HIV is complex especially in Africa due to healthcare resources, but our experience suggests that metabolic clinic is beneficial to patients and staff and should be an important part of HIV services especially as the older HIV population is increasing. In this context, cardiovascular risk assessment of HIV-infected patients will become an important component of care in developing countries in Africa and strategies are needed to deal with progressive increase in the epidemic of type 2 diabetes, dyslipidemia and metabolic syndrome. Keywords: dyslipidemia, diabetes mellitus, metabolic syndrome, cardiovascular, NAFLD, HIV services, Africa, metabolic clini