Chronic Infections and Diabetes in Africa: A Narrative Review of Pathogen-Associated Metabolic Risk.

Diabetes is increasing rapidly across Africa, where individuals in low-income areas are found to develop the disease at younger ages and lower body mass indices than those in high-income regions. Traditional metabolic risk factors explain only part of this trend, prompting growing interest in the role of chronic infections as contributors to dysglycemia. Persistent exposure to pathogens such as HIV, tuberculosis, hepatitis C virus, Helicobacter pylori, periodontal bacteria, cytomegalovirus, and parasitic organisms remains widespread in the region. These infections may influence glucose metabolism through sustained low-grade inflammation, immune-mediated pancreatic injury, alterations in gut microbial composition, and treatment-related metabolic effects. This narrative review synthesizes current evidence on the infectious determinants of metabolic dysfunction, with a focus on pathogens of high relevance in African settings. The strongest epidemiological signals link HIV infection and antiretroviral therapy exposure, chronic hepatitis C virus infection, and tuberculosis with impaired glucose regulation. Evidence for H. pylori, periodontal disease, and parasitic infections is emerging, but the findings are less consistent. African studies support the plausibility of infection-related metabolic disturbances, although most available investigations are cross-sectional, which limits causal inference. Laboratory and mechanistic research remains sparse, and diagnostic variability further constrains interpretation. The review highlights several clinical implications, including the value of incorporating glycemic screening into HIV and tuberculosis programs, the need to consider metabolic effects when selecting antimicrobial therapies, and the importance of integrating lifestyle counselling into chronic infection care. Strengthening longitudinal research, improving diagnostic standardization, and developing integrated infectious disease-non-communicable disease care models will be essential for addressing the intertwined burdens of infection and diabetes in Africa. Understanding how chronic pathogens interact with metabolic pathways may help refine prevention strategies and promote earlier detection of dysglycemia in high-risk populations.