Noninfectious Comorbidity in the African Cohort Study

Abstract

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.

Body mass index and noninfectious comorbidity in HIV‐positive patients commencing antiretroviral therapy in Zimbabwe

“…The prevalence of hypertension has increased in Africa in recent decades, contrary to the decreasing trend in developed nations [16]. Amongst PLWH in sub‐Saharan Africa, the prevalence of hypertension has been reported to be between 13% and 15% [8,13]. The high prevalence of hypertension in our study cohort is particularly concerning given the strong association with a lower eGFR at baseline and 6 months.…”

“…While complications of advanced HIV infection, such as opportunistic infections and cancer, are undoubtedly associated with malnutrition and low BMI, it has been suggested that excess body mass exerts an independent protective effect against HIV disease progression [7]. The interaction of BMI with HIV-specific outcomes in Sub-Saharan Africa is not well described and the wide variation in food security and obesity rates across the region makes local data essential for public health decision making [8][9][10][11]. Here, we report the prevalence of overweight and obesity and its association with NICMs, particularly hypertension and CKD, in a cohort of treatment-na€ ıve PLWH commencing ART at the Newlands Clinic in Harare, Zimbabwe.…”

Decreasing time to antiretroviral therapy initiation after HIV diagnosis in a clinic‐based observational cohort study in four African countries

“…These analyses used data from the African Cohort Study (AFRICOS), a longitudinal cohort enrolling adults engaged in care at 12 sites in Uganda, Kenya, Tanzania and Nigeria supported by the President's Emergency Plan for AIDS Relief (PEPFAR). AFRICOS participants provided a medical history, completed a physical examination and underwent laboratory assessments every six months as described previously . HIV diagnosis dates, ART start dates and CD4 nadir were obtained from medical record review.…”

Attaining 95-95-95 through Implementation Science: 15 Years of Insights and Best Practices from the Walter Reed Army Institute of Research’s Implementation of the U.S. President’s Emergency Plan for AIDS Relief

“…36 African Cohort Study findings suggest that PLHIV on ART had an increased risk of noncommunicable diseases compared with those not on ART. 37 In addition, the AFRICOS is being used to monitor the transition to dolutegravir as first-line treatment, providing real-time data to inform program improvement. Preliminary data show that participants prescribed tenofovir/ lamivudine/dolutegravir (TLD) developed a higher BMI than those on other ART regimens (unpublished).…”

“…Comprehensive care will need to address noncommunicable diseases in PLHIV as they survive to older ages. 37 The cohort has also identified mental health as a driver of HIV outcomes, for example, describing depression as a predictor of HIV viral load. 38 Leveraging PEPFAR sites for impact.…”