Non‐communicable diseases by age strata in people living with and without HIV in four African countries

Abstract

Introduction: Non-communicable diseases (NCDs) are an important driver of morbidity among ageing people living with HIV (PLWH). We examined the composite role of age and HIV status on NCDs in people living with and without HIV. Methods: The African Cohort Study (AFRICOS) prospectively enrols participants aged ≥15 years with and without HIV at 12 sites in Kenya, Tanzania, Uganda and Nigeria. From 21 January 2013 to 1 September 2021, we assessed participants for renal insufficiency (estimated glomerular filtration rate <60 ml/minute/1.73 m 2 ), elevated blood pressure (BP) (any systolic BP >139 mmHg or diastolic BP >89 mmHg), obesity (body mass index >30 kg/m 2 ), diabetes mellitus (DM) (fasting glucose ≥126 mg/dl or antidiabetic medication) and dysglycemia (fasting glucose ≥99 mg/dl or non-fasting ≥199 mg/dl). Multivariable logistic regression with generalized estimating equations was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for factors associated with each NCD. The main exposure of interest was a composite of HIV status and age dichotomized around 50 years. All models were adjusted for study site and sex. The renal insufficiency model was additionally adjusted for elevated BP and dysglycemia. Results and discussion: Of 3761 participants with age data, 557 (14.8%) were age ≥50, 2188 (58.2%) were females and 3099 (82.4%) were PLWH. At enrolment, the prevalence of elevated BP, dysglycemia, renal insufficiency and obesity were n = 128 (26.9%), n = 75 (15.8%), n = 8 (1.7%) and n = 40 (8.4%), respectively, for PLWH ≥50. Compared to people without HIV age <50, PLWH age ≥50 had increased adjusted odds of having DM (OR: 2.78, 95% CI: 1.49-5.16), dysglycemia (OR: 1.98, 95% CI: 1.51-2.61) and renal insufficiency (OR: 6.20, 95% CI: 2.31-16.66). There were significant differences by study site, specifically, participants from Nigeria had the highest odds of elevated BP, dysglycemia and renal insufficiency as compared to Uganda. Conclusions: There was a high burden of NCDs in this African cohort with differences by geographic region. In order to promote healthy ageing with HIV, screening and treatment for common NCDs should be incorporated into routine HIV care with attention paid to geographic heterogeneity to better allocate resources.

Non-communicable disease comorbidities in HIV patients: diabetes, hypertension, heart disease, and obstructive sleep apnea as a neglected issue

“…ART effects on lifespans led PLWH to be exposed to NCD risk factors as much as normal people 7 , 16 . The rapid change in demographic characteristics of this population and the epidemiological transition enhanced by unhealthy behaviors such as an unhealthy diet and lower physical activity could increase the chance of NCDs 43 . Hypertension is one of the main cardiovascular disease (CVD) risk factors 44 .…”

Forecasting the effect of HIV-targeted interventions on the age distribution of people with HIV in Kenya

“…(325 000-429 000) PWH were over age 50, representing 26% (23-29%) of all PWH. Without additional intervention, the median age increased to 43 (39)(40)(41)(42)(43)(44)(45)(46) in 2040, with 479 000 (364 000-600 000) over age 50 (or 34% (26-43%) of all PWH, Fig. 3; Table S3 [26][27][28][29][30][31][32][33][34]) versus women (22 [19-24]).…”

“…Additional research in this setting will hopefully lead to a reevaluation of the care needs of African PWH. For instance, recent studies of NCDs among PWH in Africa have found high rates of elevated blood pressure, dysglycemia, renal insufficiency, and obesity [40][41][42][43][44].…”

The met and unmet health needs for HIV, hypertension, and diabetes in rural KwaZulu-Natal, South Africa: analysis of a cross-sectional multimorbidity survey

“… 9 , 10 , 11 , 12 , 13 , 14 This convergence could be linked to the ageing HIV-positive population in these regions, the associated increasing burden of non-communicable diseases among these individuals, and the hastening effect of HIV on non-communicable disease acquisition. 15 Managing the convergence of diseases is of even greater concern since the beginning of the COVID-19 pandemic because poorly controlled multimorbidity has been associated with an increased risk of severe outcomes from COVID-19. 16 , 17 Moreover, an increase in ageing among people living with HIV as a result of the success of antiretroviral therapy has seen a subsequent increase in non-communicable diseases in this group, resulting in recognition of the need for integrated infectious disease programmes and non-communicable disease care and prevention programmes to avoid a loss of health gains made through antiretroviral therapy.…”