Article Abstract

HIV metabolic clinic: can the journey start from a UK clinic to a sub-Saharan African nation?

Authors: Mohamed H. Ahmed, Selani Gooneratne, Sophie Bondje, Fathima Rawther, Adelaide Duku, Dushyant Mital

Abstract

As a result of effective treatment and care, the HIV population is living longer and facing the issues of ageing, which in turn will present the challenges of dealing with an increased prevalence of dyslipidemia, diabetes, metabolic syndrome (MetS) and nonalcoholic fatty liver disease (NAFLD). Combination antiretroviral therapy (cART) decreases mortality and morbidity in HIV patients, but can leads to an increase incidence of in insulin resistance, dyslipidemia, abnormalities of fat distribution and higher risk of cardiovascular disease (CVD). Therefore, a metabolic clinic was established for individuals living with HIV in the Milton Keynes University Hospital (MKUH) NHS Foundation Trust in 2014 to provide a focus on these issues and involve specialised care in a multi-disciplinary type care to avoid expensive community care. In this review, we will argue the need to replicate such a model of care the metabolic clinic in sub-Saharan African (SSA) where the burden of HIV is high. An extensive search and analysis was carried out using PubMed and Google scholar published-English literature since 1996 were critically reviewed. The peak prevalence of diagnosed diabetes mellitus (DM) in HIV infection for SSA can be as high as 26.5%, prediabetes 43.5%, MetS 58% and dyslipidemia 70%. Also, HIV-associated nephropathy (HIVAN) in Africa is estimated to affect around 35–70%. These factors (diabetes, dyslipidaemia, and nephropathy) may predict an increase in CVD in Africa. Therefore, there is an urgent need to manage these complex factors and CVD in specialized metabolic clinics in African countries. We are aware the cost of establishing and running metabolic clinic may add more financial strain to potentially the under-resourced health care systems in SSA but this may be cost effective in the long run. Importantly, our experience suggests that metabolic clinic is beneficial to patients and staff and should be an essential part of HIV services especially as our ageing HIV population is increasing. This will come with the benefit of not only managing CVD and developing strategies to deal with the epidemic of diabetes but also with establishing research and clinical trials, in such diverse populations in Africa.