Noninfectious Comorbidity in the African Cohort Study.
Africa
HIV
comorbidity
noninfectious
Journal
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
ISSN: 1537-6591
Titre abrégé: Clin Infect Dis
Pays: United States
ID NLM: 9203213
Informations de publication
Date de publication:
01 08 2019
01 08 2019
Historique:
received:
03
06
2018
accepted:
20
11
2018
pubmed:
27
11
2018
medline:
17
6
2020
entrez:
27
11
2018
Statut:
ppublish
Résumé
Noninfectious comorbid diseases (NCDs) contribute to morbidity and mortality in human immunodeficiency virus (HIV)-infected populations in resource-rich countries. With antiretroviral therapy (ART) scale-up in Africa, understanding burden NCD informs public health strategy. At enrollment, participants at 11 HIV clinics in Kenya, Uganda, Tanzania, and Nigeria underwent medical history, physical, laboratory, and neuropsychological assessments to identify elevated blood pressure, hypercholesterolemia, dysglycemia, renal insufficiency, and cognitive impairment. Poisson regression models estimated adjusted relative risks (ARRs) and 95% confidence intervals (CIs) for the number of NCDs associated with factors of interest. Logistic regression was used to evaluate each NCD separately among HIV-infected participants. Among 2720 participants with complete NCD data, 2159 (79.4%) were HIV-infected. Of those, 1426 (66.0%) were taking ART and 813 (37.7%) had at least 1 NCD. HIV infection was associated with more NCDs, especially with ART (ARR, 1.42; 95% CI, 1.22-1.66). In addition to age, body mass index, and program site, ART usage was associated with more NCDs (ARR, 1.50; 95% CI, 1.27-1.78 for virologically suppressed and ARR, 1.38; 95% CI, 1.13-1.68 for viremic) among HIV-infected participants. In participants taking ART, CD4 nadir below 200 cells/mm3 was associated with more NCDs (ARR, 1.43; 95% CI, 1.06-1.93). ART use was independently associated with hypercholesterolemia and dysglycemia. Program site was significantly associated with all comorbidities except renal insufficiency. HIV infection was a risk for NCDs, which were common in HIV-infected participants, geographically variable, and largely consistent with metabolic complications of first-line ART.
Sections du résumé
BACKGROUND
Noninfectious comorbid diseases (NCDs) contribute to morbidity and mortality in human immunodeficiency virus (HIV)-infected populations in resource-rich countries. With antiretroviral therapy (ART) scale-up in Africa, understanding burden NCD informs public health strategy.
METHODS
At enrollment, participants at 11 HIV clinics in Kenya, Uganda, Tanzania, and Nigeria underwent medical history, physical, laboratory, and neuropsychological assessments to identify elevated blood pressure, hypercholesterolemia, dysglycemia, renal insufficiency, and cognitive impairment. Poisson regression models estimated adjusted relative risks (ARRs) and 95% confidence intervals (CIs) for the number of NCDs associated with factors of interest. Logistic regression was used to evaluate each NCD separately among HIV-infected participants.
RESULTS
Among 2720 participants with complete NCD data, 2159 (79.4%) were HIV-infected. Of those, 1426 (66.0%) were taking ART and 813 (37.7%) had at least 1 NCD. HIV infection was associated with more NCDs, especially with ART (ARR, 1.42; 95% CI, 1.22-1.66). In addition to age, body mass index, and program site, ART usage was associated with more NCDs (ARR, 1.50; 95% CI, 1.27-1.78 for virologically suppressed and ARR, 1.38; 95% CI, 1.13-1.68 for viremic) among HIV-infected participants. In participants taking ART, CD4 nadir below 200 cells/mm3 was associated with more NCDs (ARR, 1.43; 95% CI, 1.06-1.93). ART use was independently associated with hypercholesterolemia and dysglycemia. Program site was significantly associated with all comorbidities except renal insufficiency.
CONCLUSIONS
HIV infection was a risk for NCDs, which were common in HIV-infected participants, geographically variable, and largely consistent with metabolic complications of first-line ART.
Identifiants
pubmed: 30476001
pii: 5208355
doi: 10.1093/cid/ciy981
pmc: PMC6669288
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
639-647Subventions
Organisme : NIMH NIH HHS
ID : K24 MH098759
Pays : United States
Organisme : PEPFAR
Pays : United States
Investigateurs
O Falodun
(O)
K Song
(K)
M Milazzo
(M)
C Zhang
(C)
R Deshano
(R)
C Thompson
(C)
G Smith
(G)
T Mebrahtu
(T)
P Coakley
(P)
K Lombardi
(K)
M Imbach
(M)
S Peel
(S)
J Malia
(J)
A Kroidl
(A)
I Kroidl
(I)
C Geldmacher
(C)
C Kafeero
(C)
A Nambuya
(A)
J Tegamanyi
(J)
H Birungi
(H)
O Mugagga
(O)
G Nassali
(G)
P Wangiri
(P)
M Nantabo
(M)
P Nambulondo
(P)
B Atwijuka
(B)
A Asiimwe
(A)
C T Nabanoba
(CT)
M Semwogerere
(M)
R Mwesigwa
(R)
S Jjuuko
(S)
R Namagembe
(R)
E Bagyendagye
(E)
A Tindikahwa
(A)
I Rwomushana
(I)
F Ssentongo
(F)
H Kibuuka
(H)
M Millard
(M)
J Kapkiai
(J)
S Wangare
(S)
R Mangesoi
(R)
P Chepkwony
(P)
L Bor
(L)
E Maera
(E)
A Kasembeli
(A)
J Rotich
(J)
C Kipkoech
(C)
W Chepkemoi
(W)
A Rono
(A)
Z Kesi
(Z)
J Ngeno
(J)
E Langat
(E)
K Labosso
(K)
K Langat
(K)
R Kirui
(R)
L Rotich
(L)
M Mabwai
(M)
E Chelangat
(E)
J Agutu
(J)
C Tonui
(C)
E Changwony
(E)
M Bii
(M)
E Chumba
(E)
J Korir
(J)
J Sugut
(J)
D Gitonga
(D)
R Ngetich
(R)
S Kiprotich
(S)
W Rehema
(W)
C Ogari
(C)
I Ouma
(I)
O Adimo
(O)
S Ogai
(S)
C Okwaro
(C)
E Maranga
(E)
J Ochola
(J)
K Obambo
(K)
V Sing'oei
(V)
L Otieno
(L)
O Nyapiedho
(O)
N Sande
(N)
E Odemba
(E)
F Wanjiru
(F)
S Khamadi
(S)
E Chiweka
(E)
A Lwilla
(A)
D Mkondoo
(D)
N Somi
(N)
P Kiliba
(P)
M Mwaipopo
(M)
G Mwaisanga
(G)
J Muhumuza
(J)
N Mkingule
(N)
O Mwasulama
(O)
A Sanagare
(A)
P Kishimbo
(P)
G David
(G)
F Mbwayu
(F)
J Mwamwaja
(J)
J Likiliwike
(J)
J Muhumuza
(J)
R Mcharo
(R)
N Mkingule
(N)
O Mwasulama
(O)
B Mtafya
(B)
C Lueer
(C)
A Kisinda
(A)
T Mbena
(T)
H Mfumbulwa
(H)
L Mwandumbya
(L)
P Edwin
(P)
W Olomi
(W)
Y Adamu
(Y)
A Akintunde
(A)
A B Tiamiyu
(AB)
K Afoke
(K)
M Shehu
(M)
N E Harrison
(NE)
U C Agbaim
(UC)
O A Adegbite
(OA)
R M Eluwa
(RM)
G A Adelakun
(GA)
A U Ikegbunam
(AU)
J C Mbibi
(JC)
F O Oni
(FO)
R O Ndbuisi
(RO)
J Elemere
(J)
N Azuakola
(N)
T T Williams
(TT)
M Ayogu
(M)
O Enameguono
(O)
A F Odo
(AF)
I C Ukaegbu
(IC)
O Ugwuezumba
(O)
S O Odeyemi
(SO)
N C Okeke
(NC)
L Umeji
(L)
A Rose
(A)
H Daniel
(H)
H Nwando
(H)
E I Nicholas
(EI)
T Iyanda
(T)
C Okolo
(C)
V Y Mene
(VY)
B Dogonyaro
(B)
O Olabulo
(O)
O Akinseli
(O)
F Onukun
(F)
G Knopp
(G)
Informations de copyright
Published by Oxford University Press for the Infectious Diseases Society of America 2018.
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