Research Proposal Msc2 Full Copy).Doc11

8/12/2019 Research Proposal Msc2 Full Copy).Doc11

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GLYCATED HEMOGLOBIN AIc TEST AS SCREENING TOOL TO

ASSESS GLYCEMIC

CONTROL IN HIV INFECTED DIABETIC AND NON DIABETIC

PATIENTS IN ARV CLINICS IN, LAGOS NIGERIA.

BY

DR EYISANMI YETUNDE .C.

DEPARTMENT OF CLINICAL PATHOLOGY

LAGOS UNIVERSITY TEACHING HOSPITAL

IDI-ARABA, LAGOS.

RESEARCH PROPOSAL TOWARDS PARTIAL FULFILMENT OF

REQUIREMENTS

FOR AWARD OF Msc. CLINICAL PATHOLOGY DEGREE.

SUPERVISOR

DR O.O.SORIYAN MBBS (Ibd MWACP (!"b #$d%c%&$ FMCP"'

(C$#%c"! )"'*!*+, !$c'$ "&d c*&s!'"&' c$#%c"! )"'*!*+%s'

C!%&%c"! )"'*!*+ d$)' CMUL/LUTH.

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TABLE OF CONTENTS

CHAPTER ONE

INTRODUCTION

CHAPTER TWO

AIMS AND OBJECTIVE

CHAPTER THREE

LITERATURE REVIEW

CHAPTER FOUR

SUBJECTS AND METHODS

REFERNCES

APPENDIX 1: INFORMED CONSENT FORM

APPENDIX 2: QUESTIONNAIRE

CHAPTER ONE

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INTRODUCTION

Over 22.9 !""!#$ %e#%"e !$ &'()S*+*r*$ A,r!-* *re !$,e-e/ 0!+ HIV

re%re&e$!$ $e*r"3 456 #, +e 0#r"/7& #*" %#%'"*!#$ #, %e#%"e "!v!$ 0!+

HIV *$/ AIDS 8PLWHA.1

S'(&*$!*" ,'$/!$ ,r# #ver$e$& *$/ $#$)#ver$e$ r#'%& +*&

"e/ # * /r**!- &-*"e)'% !$ %r#v!&!#$ #, +!+"3 *-!ve *$!rer#v!r*"

re*e$ 8HAART *-r#&& +e -#$!$e$ !$ +e "*& /e-*/e.1

T+ere *re $#0 #ver !""!#$ A,r!-*$& #$ HAART1 T+!& !& * re)

*r;*("e ,e* !ve$ +e -+*""e$e& #, %r#v!/!$ HIV -*re !$ re'r-e)

"!!e/ &e!$&. I$/ee/ HAART +*& &!$!,!-*$"3 *"ere/ +e $*'r*" +!r3

#, +!& "!,e)+re*e$!$ -#$/!!#$.2

A& -+!"/re$ *$/ */'"& *re "!v!$ "#$er #$ HAART +ere !& !$-re*&!$

-#$-er$ *(#' r!&!$ !$-!/e$-e #, !$&'"!$ re&!&*$-e "'-#&e !$#"er*$-e

3%e 2 /!*(ee& *$/ /3&"!%!/e!* *#$ PLWHA8Pe#%"e "!v!$ 0!+ *!/&. . I$ ,*- HIVAIDS +*& (e-#e -+r#$!- !""$e&& ,#r *$3

%*!e$& #$ HAART 0!+ +e !$-re*&e/ &'rv!v*" #, +e&e %*!e$& +ere

+*ve eere/ * $'(er #, '$e%e-e/ -#$&e'e$-e& #, -+r#$!- !""$e&&

e&%e-!*""3 !$ +e ,#r #, e*(#"!- /!&e*&e.1>

T+e v!r*" ('r/e$ *$/ &re&& +* *re %re&e$ !$ HIV)!$,e-e/ %*!e$& e"!-! *

-#%"e +#r#$*" *$/ !'$#"#!- re&%#$&e +* *3 *"er v*r!#'&

(!#-+e!-*" %*+0*3& !$-"'/!$ "'-#&e e*(#"!&.14

S!$-e +e */ve$ #, +!+"3 *-!ve *$!rer#v!r*" +er*%3 8HAART !$ +e

!/)1995& *($#r*"!!e& !$ "'-#&e +#e#&*&!& +*ve (ee$ re%#re/ 0!+

!$-re*&!$ ,re'e$-3 !$ %er$& !$,e-e/ 0!+ +'*$ !'$#/e,!-!e$-3

v!r'& 8HIV 1@. I$&'"!$ re&!&*$-e *$/ "'-#&e !$#"er*$-e 0ere re%#re/ #

(e '$-##$ !$ HIV)1 !$,e-!#$ %r!#r # +e '&e #, %#e$ *$!rer#v!r*"

re!e$&.

EPIDEMIOLOGY

W!+ +e *r;e/ !$-re*&e 0#r"/0!/e !$ +e !$-!/e$-e *$/ %rev*"e$-e

#, /!,,ere$ ,#r& #, /!*(ee& +ere +*& (ee$ re* !$ere& !$ /eer!$!$

+e ,re'e$-3 *$/ -+*r*-er!&!-& #, /!r/er& #, "'-#&e e*(#"!&

8/!*(ee& !%*!re/ "'-#&e #"er*$-e 8IT e- !$ HIV)!$,e-e/ %*!e$&.19

T+e e%!/e!#"#3 #, DM +*& (ee$ &'/!e/ # * "!!e/ ee$ !$

*$!rer#v!r*")$*ve HIV %*!e$&. I$ * &'/3 0+!-+ e$r#""e/ =19 r*-!*""3

/!ver&e *$!rer#v!r*")$*ve %*!e$& +e (*&e"!$e %rev*"e$-e #, DM 0*&

2.>6G.25A &!!"*r r#'% #, %*!e$& +*/ * +!+er (*&e"!$e %rev*"e$-e #,/!*(ee& e""!'& 0+e$ -# !$,e-e/ 0!+ +e%*!!& C v!r'& 8HIVHCV -#

!$,e-e/ r#'% .96 v&.


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+#&e re%#r!$ $#$)PI)-#$*!$!$ HAART +*/ * DM !$-!/e$-e #, 2.@9155

%er$)3e*r&. T+e !$-!/e$-e #, DM *#$ HIV)'$!$,e-e/ 0#e$ 0*&

1.9>155 %er$)3e*r&22.

M#& e%!/e!#"#!-*" /** re*r/!$ DM *$/ IT -#e ,r# &'/!e, %*!e$& #$ HAART2


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T# *//re&& +!& !&&'e /** -#""e-e/ !$ +e He*r P#&!!ve &'/3 0*&

*$*"3e/ ) * "*re '"!e+$!- &'/3 #, +3%err!"3-er!/e!- (' #+er0!&e

+e*"+3 %*!e$& 0!+ HIV !$,e-!#$ #$ &*("e HAART *"" #, 0+# re%#re/

$# +!r3 #, /!*(ee& *$/ '$/er0e$ #r*" "'-#&e #"er*$-e e&!$=1A$ ee$&!ve &e*r-+ #, +#&%!*" /**(*&e& &+#0e/ +* +e r*e #,

*-'e MI 0*& +!+er !$ *$ HIV)!$,e-e/ -#+#r #ver $#$)HIV %*!e$& 0!+ *

re"*!ve r!&; #, 1.4 eve$ *,er */'&!$ ,#r *e e$/er r*-e

+3%ere$&!#$ DM *$/ /3&"!%!/e!*=2.

DISORDERS OF GLUCOSE METABOLISM IN HIV

A &%e-r' #, /!r/er& #, "'-#&e e*(#"!& +*& (ee$ *&-!*e/

0!+ HIV !$,e-!#$ *$/ *$!rer#v!r*" +er*%3.

INSULIN RESISTANCE #--'r& 0+e$ +e *re !&&'e& #, !$&'"!$ *-!#$ ,*!"

# re&%#$/ *%%r#%r!*e"3 # !$&'"!$ re&'"!$ !$ !$-re*&e/ %*$-re*!- !$&'"!$

%r#/'-!#$.

IMPAIRED LUCOSE TOLERANCE !& *$ e"ev*e/ ("##/ &'*r "eve" #,

1=5)199 /L 2 + *,er re-e!% #, * 4) "#*/!$ /#&e #, "'-#&e /'r!$ *$

#r*" "'-#&e #"er*$-e e&.

@


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IMPAIRED FASTIN LUCOSE #--'r& 0+e$ +e ,*&!$ ("##/ &'*r "eve"

!& !$ +e 155)12)/L r*$e.

DIABETES MELLITUS 8DM !& /!*$#&e/ 0+e$ +e ,*&!$ ("##/ &'*r

"eve" !& K12> /L #r +e 2)+ #r*" "'-#&e #"er*$-e e& "'-#&e "eve" !&K255 /L *$/ !& -#$,!re/ (3 *//!!#$*" e&!$ #r 0+e$ * %*!e$ +*&

&3%#& #, DM 8,re'e$ 'r!$*!#$ +!r& ("'rre/ v!&!#$ #r 0e!+ "#&& !$

+e &e!$ #, * ("##/ "'-#&e "eve" K255 /L.

RIS1 FACTORS

R!&; ,*-#r& ,#r +e /eve"#%e$ #, /!r/er& #, "'-#&e e*(#"!& !$

HIV !$,e-e/ %e#%"e !$-"'/e

O(e&!3

I$ * "*re '"!$*!#$*" -#+#r *$*"3&!& #, HIV)!$,e-e/ !$/!v!/'*"&

/!*(ee& r*e& 0ere 0#),#"/ +!+er !$ #(e&e %*r!-!%*$& -#%*re/ 0!+

+#&e 0!+ $#r*" (#/3 *&& !$/e 8BMI.=< F* /!&r!('!#$ !& #re

%re/!-!ve +*$ BMI ,#r !$-!/e$-e #, /!*(ee&: %*!e$& 0!+ HIV *$/ +!+er

&e)*%%r#%r!*e 0*!& +!% r*!#& *re *" ,*r #re "!;e"3 # /eve"#%

/!*(ee&.==

L!%#/3&r#%+3

I re,"e-& %r#,#'$/ /e,e-& !$ "!%!/ 'r$#ver ;!$e!-& = => *$/ -"e*r"3

!$/'-e& &evere !$&'"!$ re&!&*$-e *$/ +e e$/e$-3 # +3%er"3-e!*.

H3%er!$&'"!$e!-)e'"3-e!- -"*% &'/!e& +*ve /e#$&r*e/ +*

-#%*re/ # $#$)"!%#/3&r#%+!- %*!e$& HIV %*!e$& 0!+ "!%#/3&r#%+3

+*ve /e-re*&e/ !$&'"!$)&!'"*e/ "'-#&e /!&%#&*" =4=@ !$-re*&e/

!$r*3#-e""'"*r "!%!/ *$/ !%*!re/ &;e"e*" '&-"e "'-#&e

'%*;e=9L!%#/3&r#%+!- %*!e$& *" +*ve !$-re*&e/ ,*&!$ %"*&* "eve"&

#, ,ree ,*3 *-!/& *$/ !$&'"!$ 5 *$/ * +!+er %er-e$*e #, +e%*!- ,*

8*&-!*e/ 0!+ !$-re*&e/ &er' !$&'"!$ "eve"& 1.

O"/er *e

9


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O"/er %e#%"e 8K> 3e*r& 0!+ HIV *re '% # ,#'r !e& #re "!;e"3 #

/eve"#% /!*(ee& -#%*re/ 0!+ +#&e '$/er +e *e #, 5 3e*r&. 2

R*-e

W+!"e +ere +*& (ee$ * re* /e*" #, re&e*r-+ !$# +#0 r*-e *,,e-& +e

/eve"#%e$ #, /!*(ee& !$ 0e&er$!e/ $*!#$& ver3 "!"e !& ;$#0$ *(#'

+e -#%"e !$er%"*3 #, r*-e *$/ #+er -!e*" ,*-#r& #$ +e /eve"#%e$

#, /!*(ee& *#$ PLWHA !$ A,r!-*.5. T+e *&-!*!#$ (e0ee$ "#0 Te&er#$e *$/ DM *$/ !$&'"!$

re&!&*$-e !& "!;e"3 e/!*e/ (3 (#/3 ,* &%e-!,!-*""3 (3 v!&-er*" */!%#&e

!&&'e. A/!%#&e)/er!ve/ ,*-#r& !$+!(! +e +3%#+*"*!-%!'!*r3#$*/*"

8HP *!& 0+!-+ /e-re*&e& Te&er#$e 0+!-+ %r##e& ,'r+er

*--''"*!#$ #, */!%#&e !&&'e. T+!& !$ 'r$ %r##e& ,'r+er !$&'"!$

re&!&*$-e. Te&er#$e *3 *" *- !$/e%e$/e$"3 (3 /e-re*&!$ '&-"e

!$&'"!$ &e$&!!v!3>5. H3%er *$/r#e$!- -#$/!!#$& &'-+ *& %#"3-3&!-15


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#v*r!*$ &3$/r#e 8PCOS +*ve (ee$ &r#$"3 *&-!*e/ 0!+ "'-#&e

!$#"er*$-e *$/ !$&'"!$ re&!&*$-e !$ 0#e$>5* . Se +#r#$e(!$/!$

"#('"!$ 8SHB * &er' %r#e!$ +* *,,e-& ,ree -!r-'"*!$ +#r#$e

"eve"& +*& (ee$ !$ver&e"3 *&-!*e/ 0!+ !$&'"!$ re&!&*$-e *$/ 3%e 2

/!*(ee& !$ (#+ &ee&.>5

CD= -#'$.

T+ere /#e& $# &ee # (e * /!re- *&-!*!#$ (e0ee$ +e CD= -#'$ #r

+e /'r*!#$ #, !$,e-!#$ *$/ +e r!&; #, /eve"#%!$ /!*(ee& >1 >2. T+ere !&

*" -#$,"!-!$ ev!/e$-e *& # 0+e+er CD= $*/!r !& *&-!*e/ 0!+ *$

!$-re*&e/ r!&; #, /!*(ee&. I$ #$e re-e$ *$*"3&!& HIV)!$,e-e/ e$ 0!+ *

"#0er $*/!r CD= -#'$ +*/ *$ !$-re*&e/ r!&; #, !$-!/e$ "'-#&e

*($#r*"!!e& -#%*re/ 0!+ +#&e 0!+ +!+er $*/!r CD= -#'$&>=.H#0ever !$ *$#+er Fre$-+ -#+#r &'/3 #, HIV)!$,e-e/ %*!e$& ,#""#0e/

,#r 15 3e*r& +ere 0*& $# *&-!*!#$ (e0ee$ CD= $*/!r *$/ +e #$&e #,

/!*(ee&.>2

Re'r$ # +e*"+7 %+e$#e$#$.

W!+ +e !$r#/'-!#$ #, *$!)rer#v!r*" #& HIV)!$,e-e/ %*!e$&

e%er!e$-e *$ !%r#vee$ !$ +e!r e$er*" +e*"+. T+!& re'r$ # +e*"+ !&

*&-!*e/ 0!+ 0e!+ *!$ !%r#ve/ *%%e!e *$/ !$-re*&e/ -*"#r!-!$*;e. T+!& !$ 'r$ -*$ "e*/ # !$&'"!$ re&!&*$-e *$/ /!*(ee&.

PATHOGENESIS OF GLUCOSE DISORDERS IN HIV

T+e e-+*$!&& #, "3-e!- /ere'"*!#$ *$/ *&-!*e/ /e,e-& !$

!$&'"!$ *-!#$ *$/ &e-re!#$ !$ HIV)!$,e-e/ %*!e$& *re $'er#'& *$/

-#%"e 0!+ $e0 !$,#r*!#$ -#$!$'*""3 &'r,*-!$.

11


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I%*!re$ #, "'-#&e e*(#"!& !& +#'+ # re&'" %re/#!$*$"3 ,r#

!&&'e !$&e$&!!v!3 # +e e,,e- #, !$&'"!$ 8!$&'"!$ re&!&*$-e. A

-#%e$&*#r3 !$-re*&e !$ !$&'"!$ &e-re!#$ !& $ee/e/ # !$+!(! +e%*!-

"'-#$e#e$e&!& *$/ # !$-re*&e '&-"e '%*;e #, "'-#&e.

M'"!%"e e-+*$!&& *re "!;e"3 # -#$r!('e # !$&'"!$ re&!&*$-e !$

+e HIV)%#&!!ve %*!e$ *;!$ ART. T+e&e e-+*$!&& *re "!;e"3 #

!$v#"ve +e /!re- e,,e-& #, *$!rer#v!r*" e/!-*!#$& +e !$/!re-

-#$&e'e$-e& #, ,* re/!&r!('!#$ -+r#$!- !$,"**#r3 -+*$e& !$/'-e/

(3 HIV *$/ +e%*!- &e*#&!&.

EFFECTS OF ANTIRETROVIRAL MEDICATIONS

N'-"e#&!/e rever&e r*$&-r!%*&e !$+!(!#r& 8NRTI&e S*v'/!$e

!/#v'/!$e

L*!v'/!$e *(*-*v!r e$#,#v!r er!-!*(!$e /!/*$#&!$e &r#$"3 "!$;e/

# +e /eve"#%e$ #, /!*(ee&.> I$ +e D: A: D7 8/** -#""e-!#$ #$

*/ver&e eve$& #, *$!)HIV /r'& -#+#r e%#&'re # S*v'/!$e 0*&

*&-!*e/ 0!+ 196 re"*!ve r!&; #, /eve"#%!$ /!*(ee&. E%#&'re #

!/#v'/!$e *$/ /!/*$#&!$e *" !$-re*&e/ +e r!&;>>. T+e&e /r'& %re)

/!&%#&e # /!*(ee& /eve"#%e$ *& * -#$&e'e$-e #, +e ,#""#0!$

e-+*$!&&:

8* Mitochondrial toxicity. Sever*" NRTI& /!re-"3 *,,e- !#-+#$/r!*",'$-!#$.>4I$ 'r$ !#-+#$/r!*" /3&,'$-!#$ +*& (ee$ !%"!-*e/ !$ +e

%*+#e$e&!& #, !$&'"!$ re&!&*$-e. S+#r)er e%#&'re # S*v'/!$e ,#r

e*%"e -*$ re/'-e !$&'"!$ &e$&!!v!3 !$ +e*"+3 v#"'$eer&.>@ A&

re*e$ '!/e"!$e& *re (e!$ '%/*e/ +e NRTI& #& -##$"3

*&-!*e/ 0!+ +e&e &!/e e,,e-& *re (e!$ %+*&e/ #'.>9

8( Lipodystrophy. Sever*" NRTI& !$-"'/!$ S*v'/!$e *$/ !/#v'/!$e

*re *&-!*e/ 0!+ /eve"#%e$ #, "!%#/3&r#%+3 0+!-+ !&e", !&

*&-!*e/ 0!+ *--e"er*e/ #$&e *$/ !$-re*&e/ %rev*"e$-e #,/!*(ee&45 41. I$ * "*re -#+#r &'/3 +e L!%#/3&r#%+3 C*&e De,!$!!#$

S'/37 +e %rev*"e$-e #, /!*(ee& 0*& 46 !$ +#&e 0!+ "!%#/3&r#%+3

*$/


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8- Pancreatitis. R*re"3 -er*!$ NRTI& -*$ -*'&e %*$-re*!!&. T+!& !$ 'r$

-*$ "e*/ # +e /eve"#%e$ #, /!*(ee&.

Pr#e*&e !$+!(!#r& 8PIS e.. !$/!$*v!r r!#$*v!r "#%!$*v!r &*'!$*v!r

***$*v!r /*r'$*v!r. T+!& -"*&& #, /r'& 0ere +e ,!r& HIV e/!-*!#$ (e !%"!-*e/ !$ +e %*+#e$e&!& #, "'-#&e *($#r*"!!e& *#$ HIV)

!$,e-e/ %*!e$&.42S'(&e'e$ re&e*r-+ +*& /e#$&r*e/ +* !$/!v!/'*"

PI& +*ve /!,,ere$ -*%*-!!e& # !$/'-e !$&'"!$ re&!&*$-e *$/ +* r!&; #,

/!*(ee& !& /#&e)4


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!$#"er*$-e. I$ +!& re*r/ !$-re*&e/ "!%#"3&!& *$/ /e%#&!!#$ #, ,*3 *-!/&

0!+!$ +e 3#-3e& *3 !$er,ere 0!+ !$&'"!$ &!$*"!$ +r#'+ e,,e-& #$

PI


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A&-!*!#$ 8ADA !$r#/'-e/ "3-*e/ +e#"#(!$ A1C 8H(A1- *& *$

*"er$*!ve # ,*&!$ ("##/ "'-#&e 8FB *$/ 2)+ #r*" "'-#&e #"er*$-e

e&& 8OTT !$ &-ree$!$ ,#r /!*(ee&. T+e3 /e,!$e/ /!*(ee& *& +*v!$ *$

H(A1- >.6@4 @@. A& 0!+ FB *$/ OTT +!& -')#,, 0*& (*&e/ #$

!$-re*&!$ r!&; #, re!$#%*+3@9. Me*&'r!$ H(A1- +*& &ever*" */v*$*ever "'-#&e e*&'ree$&.

"3-*e/ +e#"#(!$ 8heoglobin "#c$ %b"#c$ "#& #r %b#c

e!e& *" HbA2c !& * ,#r #, +e#"#(!$+* !& e*&'re/ %r!*r!"3

# !/e$!,3 +e *ver*e %"*&* "'-#&e -#$-e$r*!#$ #ver %r#"#$e/

%er!#/& #, !e *%%r#!*e"3 %rev!#'& @)120ee;&95 91. I !& ,#re/ !$ *

$#$)e$3*!- "3-*!#$ %*+0*3 (3 +e#"#(!$& e%#&'re # %"*&*

"'-#&e92. N#r*" "eve"& #, "'-#&e %r#/'-e * $#r*" *#'$ #, "3-*e/

+e#"#(!$. A& +e *ver*e *#'$ #, %"*&* "'-#&e !$-re*&e& +e,r*-!#$ #, "3-*e/ +e#"#(!$ !$-re*&e& !$ * %re/!-*("e 0*3. T+!& &erve&

*& * *r;er ,#r *ver*e ("##/ "'-#&e "eve"& #ver +e %rev!#'& #$+&

%r!#r # +e e*&'ree$. H(A1- !& * &%e-!,!- &'(3%e #, H(A. "'-#&e

(!$/& &"#0"3 # He#"#(!$ 8H( *$/ %r#/'-e& "3-#&3"*e/ He#"#(!$.

T+ere *re &ever*" 3%e& #, "3-#&3"*e/ +e#"#(!$ e*&'re& 8!$-"'/!$

#*" "3-#&3"*e/ H( *$/ H(A1 (' H(A1- 0+!-+ !& ,#re/ 0+e$ H(A !&

"3-#&3"*e/ !& $#0 -#$&!/ere/ +e (e& *$/ &*$/*r/ e*&'re.

He#"#(!$ A1C 0*& ,!r& &e%*r*e/ ,r# #+er ,#r& #, +e#"#(!$

(3 H'!&*$ *$/ Me3er!$ !$ 19@ '&!$ * -+r#*#r*%+!- -#"'$. I&

!$-re*&e !$ /!*(ee& 0*& ,!r& /e&-r!(e/ !$ 19>9 (3 S*'e" R*+ (*ret al'

T+e 2515 Aer!-*$ D!*(ee& A&-!*!#$S*$/*r/& #, Me/!-*" C*re !$

D!*(ee& *//e/ +e A1- =@ #"#" 8>.6 *& *$#+er -r!er!#$ ,#r +e

/!*$#&!& #, /!*(ee&9


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=. H(A1- !& $# !$,"'e$-e/ (3 &'//e$ "3-e!- v*r!*!#$& 8&'-+ *& '$/er

&re&& *$/ re,"e-& +e e*$ %"*&* "'-#&e "eve"& #ver +e "*& 2). H(A1- !& *"re*/3 '&e/ *& *$ !%#r*$ *re ,#r +er*%3 *$/ !& ,*!"!*r

# -"!$!-!*$&.

T+e *#r!3 #, *$',*-'rer& #, H(A1- ;!& +*ve *"re*/3

&*$/*r/!e/ +e *&&*3 ;!& # +e -'rre$ re,ere$-e &3&e&.99 155

C"!$!-*" r!*"& &'-+ *& +e D!*(ee& C#$r#" *$/ C#%"!-*!#$& Tr!*"

8DCCT *$/ +e U$!e/ ?!$/# Pr#&%e-!ve D!*(ee& S'/3 8U?PDS+*ve &+#0$ +* !%r#v!$ H(A1- e*&'re& 0!"" /e-re*&e +e

/eve"#%e$ *$/ %r#re&&!#$ #, e3e ;!/$e3 *$/ $erve -#%"!-*!#$& !$

(#+ 3%e 1 *$/ 3%e 2 /!*(ee& e""!'&.

T+e '&e #, H(A1- +*& !& "!!*!#$& ADA '!/e"!$e& &'e& H(A1- !& *$

*--e%*("e &-ree$!$ e& '$"e&& +ere *re *($#r*"!!e& !$ er3+r#-3e

&r'-'re 8e.. +e#"#(!$#%*+!e& 151 #r 'r$#ver 8e.. %re$*$-3152

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I$ +e U$!e/ S*e& A1C e&!$ "*(#r*#r!e& *re -er!,!e/ (3 +e

N*!#$*" "3-#+e#"#(!$ S*$/*r/!*!#$ Pr#r* 8NSP # &*$/*r/!e

+e **!$& +e re&'"& #, +e 199< D!*(ee& C#$r#" *$/ C#%"!-*!#$&

Tr!*" 8DCCT.

H!+er "eve"& #, H(A1-*re ,#'$/ !$ %e#%"e 0!+ %er&!&e$"3 e"ev*e/ ("##/

&'*r *& !$ /!*(ee& e""!'&.

T+e *%%r#!*e *%%!$ (e0ee$ H(A1- v*"'e& !ve$ !$ DCCT%er-e$*e 86 *$/ eA 8e&!*e/ *ver*e "'-#&e e*&'ree$& !&

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19/42

CHAPTER FOUR

SUB0ECTS AND METHODS

STUDY DESIGN

T+!& &'/3 0!"" (e * %r#&%e-!ve &'/3 #, +e &e$&!!v!3 *$/ &%e-!,!-!3

#, H(A1- *& * &-ree$!$ *$/ #$!#r!$ e& -#%*re/ # ,*&!$ ("##/"'-#&e 8FB *#$ HIV)!$,e-e/ /!*(e!- *$/ $#$)/!*(e!- %*!e$&.

8*$!rer#v!r*")re*e/ *$/ re*e$ $*ve.

STUDY POPULATION

Re-r'!e$ ,#r +e &'/3 0!"" (e * ARV -"!$!-& !$ L*#&

er#%#"!&.HIV %#&!!ve %e#%"e 0+# ,'",!"" +e &e -r!er!* 0!"" (e -*e#r!e/

*& %*!e$&7.

PATIENT SELECTION

I$-"'&!#$ -r!er!*

P*!e$& *e/ 1@ *$/ *(#ve.

B#+ *"e *$/ ,e*"e %*!e$&.

P*!e$& 0!+ -#$,!re/ HIV &er#%#&!!v!3 (3 0e&er$ ("#.

P*!e$& 0+# *re /!*(e!-.

19


20/42

P*!e$& 0+# +*ve -#e$-e/ *$!rer#v!r*" +er*%3 ,#r * "e*&

>#$+& 0!"" (e re-r'!e/ *& re*e/7 r#'%.

P*!e$& 0+# +*ve $# -#e$-e/ *$!rer#v!r*" +er*%3 0!"" (e

re-r'!e/ *& re*e$) $*ve7 r#'%.

E-"'&!#$ -r!er!*

Pre$*$ 0#e$ *$/ $'r&!$ #+er&.

P*!e$& 0!+ +e#"#(!$#%*+3.

P*!e$& 0!+ re-e$ -+*$e& !$ *$!rer#v!r*" +er*%3.

P*!e$& 0!+ re-e$ ("##/ "#&& #r ("##/ r*$&,'&!#$.

P*!e$& 0!+ *$e!*.

P#"3-3+e!*.

SAMPLE SI6E DETERMINATION

S*%"e &!e /eer!$*!#$ 0!"" (e (*&e/ #$ +e T+e ,#r'"*15=

&789):/d9

$&*%"e &!e

-r!!-*" v*"'e * 96 -#$,!/e$-e "eve" '&'*""3 &e * 1.9>

%Prev*"e$-e 81>6

1)%

/%re-!&!#$ #, 156

25


21/42

I%'!$ +e v*r!*("e&

$ 81.9>2 5.1>5.@=85.12

$1.>

A &*%"e &!e #, 1.> 0*& #(*!$e/

I$ #r/er # !$-re*&e v*"!/!3 #, +e &'/3 *$ er* 4.18*%%r# 45 ,#r e*-+ r#'% #

(e &'/!e/.

T+ere,#re * #*" &*%"e &!e #, 1=5 0!"" (e '&e/ 845 ,#r HIV %#&!!ve

*$!rer#v!r*" re*e/ 45 ,#r HIV %#&!!ve %*!e$& $# #$ re*e$.

SAMPLIN TECHNIQUE

T+e &*%"!$ e-+$!'e 0!"" (e (3 &r*!,!e/ r*$/# &*%"!$.

Sr*!,!-*!#$ 0!"" (e (3 0+e+er %*!e$& +*ve (ee$ re*e/ #r $#. P*!e$&

0!"" (e r*$/#"3 &e"e-e/ e*-+ (*""#!$ 3e&7 #r $#7 ,#r &e"e-!#$.

ETHICS

T+!& &'/3 0!"" (e rev!e0e/ *$/ *%%r#ve/ (3 +e re&e*r-+ *$/ e+!-&

-#!ee #, L*#& '$!ver&!3 e*-+!$ +#&%!*". I$,#re/ -#$&e$ 0!"" (e

#(*!$e/ ,r# e*-+ %*r!-!%*$ 8&ee *%%e$/! 1.A$#$3!3 -#$,!/e$!*"!3

#, ,!$/!$& 0!"" (e e$&'re/. P*!e$& 0!"" (e *""#0e/ +e r!+ # /e-"!$e ,r#

+e &'/3 #r %r#-ee/.

DATA COLLECTION

T+!& 0#'"/ (e /#$e '&!$ /!,,ere$ re&e*r-+ ##"& *,er */e'*e

r*!$!$ *$/ e&!$. T+e3 !$-"'/e:

21


22/42

Q'e&!#$$*!re& 8&ee *%%e$/! II 0!"" (e */!$!&ere/ # &'/3 %*r!-!%*$&

# #(*!$ (*&!- /e#r*%+!- /** +!r3 #, /!*(ee& e""!'& #$&e

/'r*!#$ *$/ 3%e #, *$!)rer#v!r*" +er*%3 ,*!"3 +!r3 #, /!*(ee&

e""!'& e-.

P+3&!-*" e*&'ree$& 0!"" (e *;e$ 0+!-+ 0!"" !$-"'/e 0e!+ !$ ;!"#r*&

8; +e!+ 8- 0*!& -!r-',ere$-e 8-.BMI 8(#/3 *&& !$/e 0!"" (e

-*"-'"*e/ ,r# +e&e '&!$ +e ,#r'"* BMI0e!+8+e!+2re&'"

#(*!$e/ 0!"" (e !$ ;2 .

B!#-+e!-*" e*&'re& #, ,*&!$ ("##/ "'-#&e "3-*e/ +e#"#(!$ *$/

%*-;e/ -e"" v#"'e 0!"" (e /#$e.

I'$#"#!-*" e*&'re& #, CD= 0!"" *" (e /#$e.

SPECIMEN COLLECTION AND STORAE.

P*!e$& 0!"" (e #"/ # ,*& #ver$!+ 8"*& e*" &+#'"/ (e 12+r&

(e,#re #r$!$ -#""e-!#$.A$!&e%!- %re%*r*!#$ #, *$e-'(!*" ve!$ 0!"" (e

e,,e-e/ 0!+ e+3"*e/ &%!r! &0*(&. A #'r$!'e 0!"" (e *%%"!e/ # *!$

*--e&& # ve!$ *$/ *(#' 15"& #, ve$#'& ("##/ 0!"" (e -#""e-e/ (3

ve$!%'$-'re !$# +ree &%e-!e$ (#"e&.

2"& #, ("##/ !$# ,"'#r!/e #*"*e (#"e ,#r "'-#&e *&&*32"& #, ("##/

!$# EDTA (#"e ,#r %*-;e/ -e"" v#"'e 8PCV2"& #, ("##/ !$# EDTA

(#"e ,#r "3-*e/ +e#"#(!$ *&&*3 re*!$!$ ="& ,#r CD= *" !$#

EDTA (#"e.

T+e &%e-!e$& 0!"" (e *;e$ # +e "*(#r*#r3 ,#r %r#-e&&!$ r*e

*$/ *$*"3&!&. T+e3 0!"" (e -e$r!,'e/ *


23/42

MATERIALS AND METHODS

GLYCATED HEMOGLOBIN ASSAY) +!& 0!"" -#$&!& #, +e '*$!*!ve

e&!*!#$ #, +e %er-e$ -#$-e$r*!#$ #, "3-*e/ +e#"#(!$ 8H(A1- !$

0+#"e ("##/.PRINCIPLE OF LCATED HEMOLOBIN ASSA)"3-*e/

+e#"#(!$ 0!"" (e e*&'re/ '&!$ +e CLOVER A1- &3&e 0+!-+

-#$&!&& #, * e& -*rr!/e *$/ *$ *$*"3er. I !& * ,'""3 *'#*e/ (#r#$*e

*,,!$!3 *&&*3 8B#r#$*e (e*/!$ ,*-!"!*e& +e &e%*r*!#$ #, +e "3-*e/

+e#"#(!$ ,r*-!#$ ,r# +e $#$"3-*e/ ,r*-!#$.

T+e r*!# #, "3-*e/ +e#"#(!$ 0!+ re&%e- # #*" +e#"#(!$ !$ +e

("##/ &*%"e !& -*"-'"*e/ '&!$ +e ,#r'"*

H(A1-6A 8H(A1-#*" +e#"#(!$155B

A *$/ B *re +e &"#%e *$/ !$er-e% ,*-#r # -#rre- +e v*"'e ,#r DDCT

8/!*(ee& -#$r#" *$/ -#%"!-*!#$& r!*" re&e*r-+ r#'% -*"!(r*!#$.

PLASMA GLUCOSE ASSAY

A "'-#&e #!/*&e e+#/ 0!"" (e '&e/ # '*$!,3 %"*&* "'-#&e "eve"&.

PRINCIPLE OF LUCOSE ASSA "'-#&e !& /eer!$e/ *,ere$3*!- #!/*!#$ !$ +e %re&e$-e #, "'-#&e #!/*&e .T+e +3/r#e$

%er#!/e ,#re/ re*-& '$/er -**"3&!& #, %er#!/*&e 0!+ %+e$#" *$/ =)

*!$#%+e$*#$e # ,#r * re/ v!#"e '!$$#$e!!$e /3e *& e"!-*e.

"'-#&e #2 H2 # "'-#&e A-!/ H2#

2H2#2 =)*!$#%+e$*#$e %+e$#" POD = H2#

D3e ,#re/ !& %r#%#r!#$*" # "'-#&e -#$-e$r*!#$ #, &*%"e

A(r(*$-e #, -#"#'re/ -#%"e !& %r#%#r!#$*" # +e -#$-e$r*!#$ #,

"'-#&e !$ +e &%e-!e$. I 0!"" (e e*&'re/ * 55$.

DETERMINATION OF PAC1ED CELL VOLUME

2


24/42

PRINCIPLE) PCV #r +e*#-r! !& +e %er-e$*e #, +e #*" v#"'e #,

0+#"e ("##/ #--'%!e/ (3 %*-;e/ re/ ("##/ -e""& 0+e$ * ;$#0$ v#"'e #,

0+#"e ("##/ !& -e$r!,'e/ * -#$&*$ &%ee/ ,#r * -#$&*$ %er!#/ #, !e.

DETERMINATION OF CD;< CELL COUNTT+!& 0!"" (e e*&'re/ (3 +e (/ ,*-&-#'$ ,'""3 *'#*e/ &3&e.

DATA ANALYSIS AND MANAGEMENT

A"" /** ,#r& 0!"" (e -#""*e/ *$/ *rr*$e/ &er!*""3 .C#%"ee/ /** 0!"" (e

e$ere/ !$# M!-r#, e-e" *$/ SPSS ver&!#$1.5 8C+!-*# IL USA

&*!&!-*" %*-;*e ,#r *$*"3&!& .De&-r!%!ve &*!&!-& 0!"" (e -#%'e/ 0!+

&*$/*r/ e+#/& *$/ %re&e$e/ *& e*$& &*$/*r/ /ev!*!#$ ,re'e$-3

*("e& *$/ -+*r&. C+! &'*re 0!"" (e '&e/ # -#%*re +e *&-!*!#$(e0ee$ # -*e#r!-*" v*r!*("e&.

S'/e$ e& 0!"" (e '&e/ # -#%*re +e e*$ (e0ee$ 0# r#'%& 0!+

*'&&!*$ /!&r!('!#$. A % v*"'e #,Y5.5 0!"" (e -#$&!/ere/ # (e

&*!&!-*""3 &!$!,!-*$.

REFERENCES

2=


25/42

1. WHOUNAIDSUNICEF. Global %I()"ID* +esponse, pideic

update and health sector progress towards uni!ersal access ./##.

e$ev*: WHO 2511.

2. S**r*& ?. Prev*"e$-e *$/ %*+#e$e&!& #, /!*(ee& e""!'& !$ HIV)1 !$,e-!#$ re*e/ 0!+ -#(!$e/ *$!rer#v!r*" +er*%3. 0 "c1uir

Iune Defic *yndr 2559 5: =995.

2


26/42

2559 '%/*e (3 +e HIV e/!-!$e *&-!*!#$ #, +e I$,e-!#'&

D!&e*&e S#-!e3 #, Aer!-*. C"!$I$,e- D!& 2559=9:>1>@1

15. C#0!e CC R'& ?F B3r/)H#" DD E(er+*r/ MS F"e*"

?ME$e"*' MM e *". Prev*"e$-e #, /!*(ee& *$/ !%*!re/ ,*&!$"'-#&e !$ */'"& !$ +e U.S. %#%'"*!#$: N*!#$*" He*"+ *$/ N'r!!#$

S'rve3 1999e2552. D!*(ee& C*re 255> 29:12>=2e2

.

12. Aer!-*$ D!*(ee& A&-!*!#$. S*$/*r/& #, e/!-*" -*re !$

/!*(ee& 2515. D!*(ee& C*re 2515 9.

1. B#$#r* E T'#!"e+# J. T+e %r#& *$/ -#$& #, /!*$#&!$ /!*(ee&

0!+ A1C. D!*(ee& C*re 2511 :=21). P*!; IJ ?#"er DP. T+e %rev*"e$-e *$/ %*+#e$e&!& #, /!*(ee&

e""!'& !$ re*e/ HIV)!$,e-!#$. Be& Pr*-. Re&. C"!$. E$/#-r!$#".

Me*(. 2511 2:=>9=4@.

14. H*r/3 H E&-+ LD M#r&e D. "'-#&e /!r/er& *&-!*e/ 0!+

HIV *$/ !& /r' +er*%3 A$$ %+*r*-#+er 2551*r


27/42

19. P*!; IJ ?#"er DP. T+e %rev*"e$-e *$/ %*+#e$e&!& #, /!*(ee&

e""!'& !$ re*e/ HIV)!$,e-!#$. B$s' P"c'. R$s. C!%&. E&d*c%&*!.

M$'"b. 25119=>;?@=4@.

25.E")S*/r WM e *". E,,e-& #, HIV /!&e*&e #$ "!%!/ "'-#&e *$/ !$&'"!$"eve"&: re&'"& ,r# * "*re *$!rer#v!r*")$*!ve -#+#r. HIV. M$d. 255

?>22;121.

92. V!&$e*r0*"* F C+e$ L R*+*v*$ S Te/*"/! E. Prev*"e$-e #,

/!*(ee& e""!'& *$/ /3&"!%!/*e!* *#$ *$!rer#v!r*" $*!ve %*!e$& -#)

!$,e-e/ 0!+ +e%*!!& C v!r'& 8HCV *$/ HIV)1 -#%*re/ # %*!e$&

0!+#' -#)!$,e-!#$. J. I$,e-. 255 5:9=4@.

2=. H*/!*$ C e *". Me*(#"!- *($#r*"!!e& *$/ -*r/!#v*&-'"*r /!&e*&e

r!&; ,*-#r& !$ */'"& 0!+ +'*$ !'$#/e,!-!e$-3 v!r'& !$,e-!#$ *$/

"!%#/3&r#%+3. C"!$. I$,e-. D!&. 2551


28/42

24. P*"*-!#& R e *". I$-!/e$-e #, *$/ r!&; ,*-#r& ,#r !$&'"!$ re&!&*$-e !$

re*e$)$*!ve HIV)!$,e-e/ %*!e$& =@ 0ee;& *,er &*r!$ +!+"3 *-!ve

*$!rer#v!r*" +er*%3. A$!v!r T+er. 255> 11:29


29/42


30/42

==. $e0)#$&e /!*(ee& !$ HIV)!$,e-e/ %*!e$&: +e /** -#""e-!#$ #$

*/ver&e eve$& #, *$!)HIV /r'& 8D:A:D &'/3. Diabetes &are 255@ G

=@. Be+re$& M e *". I%*!re/ "'-#&e %+#&%+#r3"*!#$ *$/ r*$&%#r !$

&;e"e*" '&-"e -*'&e !$&'"!$ re&!&*$-e !$ HIV)1)!$,e-e/ %*!e$& 0!+

"!%#/3&r#%+3. J. C"!$. I$ve&. 2552 115:152>>. P'(Me/: 11@@@>1>1G

2. H*&&e B Le/erer(er B F'rrer H e *". M#r(!/!3 *$/ *!$ !$ HIV)

!$,e-e/ %er$&: +e S0!&& HIV -#+#r &'/3. &lin Infect Dis 2511


31/42

< T!e$ PC B*rr#$ J'&*$ JE e *". A$!rer#v!r*" +er*%!e& *&-!*e/

0!+ "!%#*r#%+3 !$ HIV)!$,e-e/ 0#e$."ID* Patient &are *TDs 2554 21:

294 2:9@15


32/42

Me$ 0!+ #r * R!&; ,#r HIV I$,e-!#$ J A-'!r I'$e De,!- S3$/r. 2511

O-#(er 1 @82: 1429811:12@@)1299.

>1.De W! S S*(!$ CA We(er R e *". I$-!/e$-e *$/ r!&; ,*-#r& ,#r $e0)

#$&e /!*(ee& !$ HIV)!$,e-e/ %*!e$&: +e /** -#""e-!#$ #$ */ver&e

eve$& #, *$!)HIV /r'& 8D:A:D &'/3. Diabetes &are 255@ 2 . C*%e*' J B#'e"#'% V ?*"** C e *". Te$)3e*r /!*(ee& !$-!/e$-e

!$ 15=> HIV)!$,e-e/ %*!e$& &*re/ #$ * -#(!$*!#$ *$!rer#v!r*"re*e$."ID* 2512 2>:


33/42

>@. F"e!&-+*$ A J#+$&e$ S S3&r# DM e *". E,,e-& #, * $'-"e#&!/e

rever&e r*$&-r!%*&e !$+!(!#r &*v'/!$e #$ "'-#&e /!&%#&*" *$/

!#-+#$/r!*" ,'$-!#$ !$ '&-"e #, +e*"+3 */'"&." 0 Physiol ndocrinol

Metab 2554 292: E1>>>49. WHO."ntiretro!iral therapy for %I( infection in adults and adolescents,

recoendations for a public health approach' e$ev* S0!er"*$/:

WHO 2515.

45. C*rr A S**r*& ? T+#r!&/#!r A e *". D!*$#&!& %re/!-!#$ *$/

$*'r*" -#'r&e #, HIV)1 %r#e*&e)!$+!(!#r)*&-!*e/ "!%#/3&r#%+3

+3%er"!%!/*e!* *$/ /!*(ee& e""!'&: * -#+#r &'/3. Lancet 1999


34/42


35/42

@. Br#0$ TT T*&&!#%#'"#& ? B#&-+ RJ S+!;'* C M-C#&e3 A.

A&-!*!#$ (e0ee$ &3&e!- !$,"**!#$ *$/ !$-!/e$ /!*(ee& !$ HIV)

!$,e-e/ %*!e$& *,er !$!!*!#$ #, *$!rer#v!r*" +er*%3. D!*(ee& C*re.

2515


36/42

9=. DCCT Re&e*r-+ r#'%. T+e e,,e- #, !$e$&!ve re*e$ #, /!*(ee&

#$ +e /eve"#%e$ *$/ %r#re&&!#$ #, "#$)er

-#%"!-*!#$& !$ !$&'"!$)/e%e$/e$ /!*(ee& e""!'&. N E$" JMe/

1994:1=e1.

99. C#$&e$&'& S*ee$. C#$&e$&'& &*ee$ #$ +e

0#r"/0!/e&*$/*r/!*!#$ #, +e +e#"#(!$ A1- e*&'ree$. D!*(ee&

C*re 2554


37/42

155. Re%#r. I%"ee$*!#$ #, &*$/*r/!*!#$ #, H(A1-

e*&'ree$.C"!$ C+e L*( Me/ 255@=>:4e@151.

152. M#&-* A P*"e*r! R D*",r*] M D! C!*$$! C'--'r' IPe""er!$! e

*". Re,ere$-e& I$erv*"&, #r +e#"#(!$ A1- !$

%re$*$ 0#e$: /** ,r# *$ I*"!*$ M'"!-e$er &'/3. C"!$C+e

255>2:11


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39/42

'$!ver&!3 e*-+!$ +#&%!*" I&+** r#*/ #,, I!re r#*/!/! *r*(* L*#&. I$*//!!#$ !, 3#' +*ve *$3 'e&!#$ *(#' 3#'r %*r!-!%*!#$ !$ +!& re&e*r-+3#' -*$ -#$*- +e %r!$-!%*" !$ve&!*#rDr E3!&*$! * /e%*re$ #,-"!$!-*" %*+#"#3 LUTH5@5


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@. H*ve 3#' (e!$ /!*$#&e/ 0!+ +e%*!!& B (e,#re^ 8* e& 8( $#

2. H*ve 3#' (e!$ /!*$#&e/ 0!+ +e%*!!& C (e,#re^ 8* e& 8( $#

22. Are 3#' -'rre$"3 *;!$ *$3 #, +e&e e/!-*!#$&^

("C#r!-#&er#!/&

(bN!*-!$

(cA$!%&3-+#!-& e.. #"*$*%!$e

29. Are 3#' -'rre$"3 (e!$ *$*e/ ,#r *$3 #, +e&e /!&e*&e&^

(" "!%#*r#%+3

(b He%*!!& B *$/ #r C

(cD3&"!%!/*e!*

2. H*ve 3#' (e!$ r*$&,'&e/ (e,#re^ 8* e& 8( $#

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