Opportunistic infections among People Living with HIV (PLHIV) with Diabetes Mellitus (DM) attending a tertiary care hospital in coastal city of South India

Abstract

Background: HIV/AIDS and Diabetes Mellitus are the diseases' known to supress cell mediated immunity and predispose patients for opportunistic infections. Hence, we conducted a study to compare the common opportunistic infections (OIs) between People Living with HIV with DM (PLHIV-DM) and PLHIV without DM (PLHIV). Methodology: PLHIV with DM and without DM (1:1) were prospectively included in the study from January 2011 to January 2012 at a tertiary care hospital in Mangalore city. Patients were classified as Diabetic if their fasting plasma glucose was ≥ 7.0mmol/l (126mg/dl) or 2-h plasma glucose was ≥11.1mmol/l (200mg/dl). Standard procedures and techniques were followed for diagnosis of OIs as per WHO guidelines. The data was entered and analyzed using Statistical Package for Social Sciences (SPSS) version 11.5. Findings: The study included 37 PLHIV with DM and 37 PLHIV without DM and both groups were treated with Anti-Retroviral Therapy (ART). Themedian age was 47 years (IQR: 41-55years) for PLHIV-DM as compared to 40 years (IQR: 35-45.5 years) for PLHIV (p<0.0001). PLHIVDM had median CD4 counts of 245 (IQR: 148-348) cells/μl compared to 150(IQR: 70-278) cells/μl for PLHIV (p = 0.02). Common OIs included oral candidiasis (49%of PLHIV-DM and 35%of PLHIV); Cryptococcal meningitis (19%of PLHIV-DMand 16%of PLHIV); Pneumocystis jiroveci pneumonia (5%of PLHIV-DM and 18%of PLHIV); extra pulmonary tuberculosis (22%of PLHIV-DM and 34.5%of PLHIV); and Cerebral toxoplasmosis (11%of PLHIV-DM and 13.5% of PLHIV). Microbiological testing of samples from PLHIV- DM,C krusei was the most common Candida species isolated from 9 out of 18 samples. Out of six pulmonary TB samples cultured, four grew Non-tuberculosis mycobacteria (NTM) and twoMycobacterium tuberculosis complexes. Conclusions: Study did not identify any significant difference in profile of opportunistic infections (OIs) between PLHIV with and without Diabetes.