Noela Owarwo’s research while affiliated with Makerere University and other places

Background Despite the high frequency of adrenal insufficiency in patients with tuberculosis or HIV, its diagnosis is often missed or delayed resulting in increased mortality. This systematic review and meta-analysis aimed to document the prevalence, significant clinical features, and predictors of adrenal insufficiency in adult patients with tuberculosis or HIV. Methods We systematically searched Medline, EMBASE, CINAHL, Cochrane Library, and Africa Journal Online databases for published studies on adrenal insufficiency in adult patients with tuberculosis or HIV. The pooled prevalence of adrenal insufficiency was determined using random-effect model meta-analysis. A narrative review was used to describe the significant clinical features and predictors of adrenal insufficiency in adult patients with tuberculosis or HIV. Results A total of 46 studies involving 4,044 adult participants (1,599 participants with tuberculosis and 2,445 participants with HIV) were included. The pooled prevalence of adrenal insufficiency in participants with tuberculosis was 33% (95% CI 22-45, I2 = 97.7%, p<0.001) and 28% (95% CI 18-38, I2 = 98.9%, p<0.001) in those with HIV. Presentation with multi-drug resistant tuberculosis, abdominal pain, salt craving, myalgia, increased severity and duration of tuberculosis disease, and the absence of nausea predicted adrenal insufficiency in participants with tuberculosis in four studies. Cytomegalovirus antigenemia positivity, rifampicin therapy, and eosinophilia of >3% were reported to predict adrenal insufficiency in participants with HIV in two studies. Conclusions Adrenal insufficiency is relatively common in adults with tuberculosis or HIV. Its timely screening, diagnosis, and management in patients with these two conditions should be encouraged to avert mortality.

Objective HIV infection increases the risk of type 2 diabetes and may influence its phenotypic profile. In this study, we aimed to compare the anthropometric and metabolic characteristics of HIV-infected and uninfected adult Ugandans with new-onset type 2 diabetes to evaluate the influence of HIV infection on specific surrogate markers of adiposity, insulin resistance, and pancreatic beta-cell function. Methods We consecutively recruited 500 HIV-infected and uninfected adult Ugandans with new-onset type 2 diabetes (diagnosed in < 3 months) from seven tertiary hospitals over a 20-month period and compared their anthropometric and metabolic characteristics to identify any significant differences. Results Of the 500 participants with new-onset type 2 diabetes, 59 (11.8%) had a self-reported history of HIV infection. Compared with HIV-uninfected participants with type 2 diabetes, participants with HIV infection and type 2 diabetes had a lower median (IQR) hip circumference (97.8 [91.0-106.0] cm vs. 104.0 [96.0-112.0], p = 0.002) and visceral fat level (8 [6–11] vs. 10 [7–12], p < 0.001) assessed using bioimpedance analysis. No statistically significant difference was noted with the markers of pancreatic beta-cell function (fasting, 30-minute, and 120-minute C-peptide concentrations, oral insulinogenic index, and homeostatic model assessment 2-beta cell function) and insulin resistance (homeostatic model assessment 2-insulin resistance) between both groups. Conclusion In our study population, HIV infection was not associated with increased adiposity, pancreatic beta-cell function, and insulin resistance. Large prospective studies are needed to investigate the effect of HIV on the pathogenesis of type 2 diabetes in adult Ugandans.