Prevalence of diabetes mellitus among Ethiopian‐born HIV patients in Israel

During the mid‐1980s and early 1990s the majority of Ethiopian Jews immigrated to Israel. Diabetes mellitus (DM) rates were exceedingly low upon their arrival, reaching 0–0.4%, but rose to 16.6% at 10–16 years post‐arrival. This may be a challenging factor in HIV patients, since metabolic abnormalities are a major concern in individuals receiving highly active antiretroviral therapy (HAART). In this study we assessed the prevalence of DM in HIV‐positive Ethiopian immigrants. Data were retrospectively obtained from 245 HIV patients treated at the Clinic of Infectious Diseases at the Meir Medical Center, Kfar Saba, Israel. DM was determined according to the following: fasting glucose >127 mg/dl; hemoglobin A1C >6.5%; blood glucose >200 mg/dl; diagnosis of DM in patient problem list. Comparison between Ethiopian and non‐Ethiopian Israelis was done by Student's t‐test and p<0.05 was considered as significant. The cohort included 176 Ethiopians and 69 other Israelis. The rate of DM in the Ethiopian group was remarkably high (22.9% vs. 4.3%, p<0.0001). We therefore analyzed both conventional as well as HIV‐related factors which may contribute to the development of DM. The data indicated that the mean age of the Ethiopian subjects was 5.5 years greater (47±1.1 SD vs. 41.5±1.4 SD, p=0.0056). Surprisingly, body mass index (BMI) was not increased among the Ethiopians, as compared with other Israelis (24.2±0.5 vs. 26.1±1.1, p=0.057). In terms of HIV‐related features, both groups received similar rates of HAART and had comparable levels of viral loads. The Ethiopian group had lower CD4 levels (477.0±18.0 /mm 3 vs. 550.1±34.7/mm 3 , p=0.046), and disclosed longer periods of time elapsed from diagnosis of HIV (8.7±0.4 years vs. 6.0±0.6, p=0.0001). In conclusion, we report a considerably high prevalence of DM among Ethiopian immigrants in Israel, who are HIV patients. Plausible risk factors are ethnic background and older age. Low CD4 levels and a longer HIV‐carrier state were also noted, which had been proposed by others to increase insulin resistance by enhanced inflammation. The possibility of an exaggerated impact of HAART protocols on glucose levels in this cohort is currently being investigated. Intriguingly, BMI was not increased in the Ethiopian group, a finding that warrants further study, and implies a lower threshold to develop DM. Our data underscores the importance of defining HIV subpopulations with increased susceptibility to DM, especially among immigrants.