1. HIV/AIDS and diabetes in
South Africa: role of
antiretroviral therapies
Zeena Nackerdien

2. Independent prevalence estimates of
HIV/AIDS and diabetes in South Africa
HIV/AIDS
prevalence
(2012)(1)
Diabetes
prevalence
(2013)(2)
• Number of HIV+-people:
6,100,000 [5,800,000 -
6,400,000]
• Adults (≥15-49 y):
17.9% [17.3% - 18.4%]
• Mean cost ART/patient
($US): 682 (3)
• Deaths due to AIDS:
240,000 [220,000 -
270,000]
• Number of diabetics:
2,600,000
• Adults (20-79y): 9.3%
[17.3% - 18.4%]
• Mean diabetes-related
costs/person ($US):
935
• Deaths related to
diabetes: 83,114
ART, antii-retroviral therapy; y, years
1. UNAIDS. HIV and AIDS (2012 estimates) 2012 [cited 2014 May]. Available from: http://www.unaids.org/en/regionscountries/countries/southafrica/
2. International Diabetes Federation. IDF Diabetes Atlas, 6th edn. Brussels, Belgium: International Diabetes Federation, 2013:
Regional overviews [cited 2014 May]. Available from: https://www.idf.org/sites/default/files/DA6_Regional_factsheets_0.pdf.
3. Multi‐Country Analysis of Treatment Costs for HIV (MATCH) conducted by the
Clinton Health Access Initiative (CHAI) in partnership with the Governments of Ethiopia, Malawi, Rwanda, South Africa and Zambia and the Center for Global Development.
Preliminary findings for discussion at the International AIDS Economics Network Pre‐Conference Meeting, July 2012. Available from: http://www.iaen.org/library/Presentation_3_Elya_Tagar.pdf

3. SOC: Maximally suppressive ART;
monitor drug interruptions & drug-
drug interactions
Pre-specified clinical indicators to start treatment
e.g., low CD4 count, ongoing monitoring,
indications for changing ART
Other considerations for special groups, co-infected patients (e.g., TB), & sero-
discordant couples
Goals for ART in adults (SA guidelines)(4)
• Maximally suppressive ART
• Improve QoL
• Reduce disabilities/deaths
• Maximal & durable viral suppression
• Restore & preserve immune function
ART, antiretroviral therapy, QoL, quality of life; SOC, standard of care, SA, South African; TB, tuberculosis
(4) Meintjes G, Maartens G, Boulle A et al. Guidelines for Antiretroviral Therapy in Adults, September 2012. SAJHIVMED 2012;13:3.

4. Drug classes & targets of SA-based ARTs (5)
EIs e.g.,
maraviroc &
enfuvirtide
NRTIs , NNRTIs & NtRTIs
e.g., ziduvidine,
abacavir, nevirapine
INSTIs e.g., raltegravir
PIs e.g., lopinavir
Eis, entry inhibitors; INSTIs, integrase inhibitors; NRTs, NNRTIs & NtRTIs, nucleoside, non-nucleoside, and nucleotide reverse transcriptase inhibitors; Pis, protease inhibitors
(5) Management of HIV/AIDS: Wikipedia; [cited 2014 May]. Available from: http://en.wikipedia.org/wiki/Management_of_HIV/AIDS.

5. Mechanisms and some drug class AEs (4)
AEs, adverse events; Eis, entry inhibitors; InSTIs, Integrase inhibitors; NRTIs and NtRTIs, nucleoside and nucleotide reverse transcriptase inhibitors; NNRTIs, Non-nucleoside reverse
transcriptase inhibitors; PIs, protease inhibitors
(4) Meintjes G, Maartens G, Boulle A, et al. Guidelines for Antiretroviral Therapy in Adults, September 2012. SAJHIVMED 2012;13:3.
NRTIs and NtRTIs
Mechanism:
Reverse
transcriptase
Inhibition
AEs: Rash, hepatitis
Mechanism:
Protease
inhibition
AEs: Cardiac conduction abnormalities,
dyslipidaemia, hyperglycemia
Mechanism:
Reverse
transcriptase
Inhibition
AEs: Rash, headache
NNRTIs
PIs
InSTIs
Mechanism:
Entry inhibitors
AEs: colds, cough, fever
Mechanism:
Reverse
transcriptase
Inhibition
AEs: lipo-atrophy , myopathy,
bone marrow suppression
EIs

6. Management of diabetes in HIV/AIDS
patients (6)
Prevention &
management
• Screening for disease onset and
associated complications, behavioral
changes, appropriate glycemic control
Switching
ARTs
• Reinforce lifestyle interventions
• Consider discontinuing problematic ARTs
causing hyperglycemia if safe & effective
alternatives are available
• Carefully consider effects of
discontinuing ARTs on virologic control &
potential AEs of new ARTs
• Antidiabetics may still be necessary after
ART substitution, in some cases
• Regularly check HbA1c levels until goal is
reached and then, periodically, as per
recommended guidelines
6. US Department of Veterans Affairs. HIV/AIDS (Diabetes). April 2009; Last reviewed/updated: October 28, 2011 [cited 2014 May].
Available from: http://www.hiv.va.gov/provider/manual-primary-care/diabetes.asp#S4X.