High prevalence of non-communicable diseases and associated risk factors amongst adults living with HIV in Cambodia

Abstract

BackgroundWith rapid expansion of antiretroviral therapy for HIV, there are rising life expectancies among people living with HIV. As a result, co-morbidity from non-communicable diseases in those living and aging with HIV is increasingly being reported. Published data on this issue have been limited in Cambodia. The aim of this study was to determine the prevalence of diabetes mellitus, hypertension and hypercholesterolemia and associated risk factors in adults living with HIV in Cambodia.MethodsThis cross-sectional study was conducted in five provinces of Cambodia from May-June 2015. Information was obtained on socio-demographic and clinical characteristics through face-to-face interviews using a structured questionnaire, and anthropometric and biochemical measurements were performed. Diabetes mellitus was diagnosed with fasting blood glucose ≥126 mg/dl, hypertension with systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥ 90 mmHg and hypercholesterolemia with fasting blood cholesterol ≥190 mg/dl. Multivariable logistic regression analyses were used to explore risk factors.ResultsThe study sample included 510 adults living with HIV; 67% were female, with a mean age of 45 (standard deviation = 8) years. Of these, 8.8% had diabetes mellitus, 15.1% had hypertension and 34.7% had hypercholesterolemia. Of the total participants with non-communicable diseases (n = 244), 47.8% had one or more diseases, and 75% were not aware of their diseases prior to the study: new disease was diagnosed in 90% of diabetes mellitus, 44% of hypertension and 90% of hypercholesterolemia. Single disease occurred in 81%, dual disease in 17% and triple disease in 2%. In adjusted analyses, those consuming 1 serving of fruit compare to 2 servings as significantly with diabetes mellitus, those eating 1 serving of fruit compare to 2 servings and using lard for cooking were significantly associated with hypertension, and those being unemployed, having monthly income less than 100 USD and being underweighted were significantly associated with hypercholesterolemia.ConclusionsThe prevalence of diabetes mellitus, hypertension and hypercholesterolemia in adults living with HIV in this study was considerably high, with most of these diseases newly identified through active screening in the survey. These findings strongly suggest that screening of non-communicable diseases should be integrated into routine HIV care in Cambodia.

Prevalence, healthcare costs and management of non-communicable diseases in people living with human immunodeficiency virus: A scoping review

“…The prevalence of hypertension amongst PLHIV was more than 10% in all but one study and was significantly higher in PLHIV than in HIV-negative controls. Studies conducted outside of Africa (with larger sample sizes), in Cambodia, Brazil, Italy and United States of America, 7 , 10 , 11 found higher rates of hypertension in PLHIV than did the studies conducted from Africa. Again, there were marked variations in the prevalence of hypertension in the Malawian and Zimbabwean studies, with rates ranging 10.8% – 44.0% and 1.0% – 8.3%, respectively.…”

“…Other studies also mentioned lifestyle factors (unhealthy diets, physical inactivity, harmful use of alcohol and smoking) as risk factors positively associated with HIV–NCD co-morbidities in PLHIV. 11 , 13 In two studies, other social determinants of health such as gender and employment status were also found to be associated with NCDs in PLHIV, where being female and being unemployed were found to be independently associated with increased risk of development of NCDs 11 , 12 ; however, the effect of these on access to treatment were not assessed.…”

High prevalence of non-communicable diseases among key populations enrolled at a large HIV prevention & treatment program in Kenya

“…Study findings from concentrated HIV epidemics that are driven by an increased prevalence of HIV among key populations, point to high prevalence of NCDs among PLHIV [25]. In a Cambodian study among PLHIV, close to half (47.8%) of total study participants had one or more NCDs with 75% unaware of their disease condition prior to the study [26]. A recent modeling report from Kenya estimated 33% of HIV negative individuals and 36% of PLHIV to have at least one NCD.…”

Nutritional status and dietary diversity of school-age children living with HIV: a cross-sectional study in Phnom Penh, Cambodia

“…Cambodia has been making tremendous strides in HIV prevention and control [ 22 ], which has led to the fact that almost all people living with HIV who knew their HIV status were receiving treatment in 2018 [ 1 ]. Further, several studies have revealed a variety of health issues faced by HIV-infected adolescents and adults in Cambodia and made recommendations to effectively tackle these issues [ 23 , 24 ]. However, few studies have been conducted in Cambodia and other Southeast Asian countries to evaluate nutritional status and dietary intake of children living with HIV, especially those of school age.…”