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. 2019 Aug 1;69(4):639-647.
doi: 10.1093/cid/ciy981.

Noninfectious Comorbidity in the African Cohort Study

Julie A Ake  1 , Christina S Polyak  1   2 , Trevor A Crowell  1   2 , Francis Kiweewa  3 , Michael Semwogerere  3 , Lucas Maganga  4 , Emmanuel Bahemana  4 , Jonah Maswai  2   5 , Rither Langat  2   5 , John Owuoth  2   5 , Solomon Otieno  2   5 , Babajide Keshinro  6 , Allahna L Esber  1   2 , Michelle Liu  1   2 , Leigh Anne Eller  1   2 , Kavitha Ganesan  1   2 , Ajay P Parikh  1   2 , Tiffany E Hamm  1   2 , Merlin L Robb  1   2 , Patrick W Hickey  1 , Victor G Valcour  7 , Nelson L Michael  1 ; African Cohort Study Team
Collaborators, Affiliations

Noninfectious Comorbidity in the African Cohort Study

Julie A Ake et al. Clin Infect Dis. .

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.

Keywords: Africa; HIV; comorbidity; noninfectious.

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Figures

Figure 1.
Figure 1.
Map of African Cohort Study sites. Kayunga, Uganda: Kayunga District Hospital; South Rift Valley, Kenya: Kericho District Hospital, AC Litein Mission Hospital, Kapkatet District Hospital, Tenwek Mission Hospital, Kapsabet District Hospital, Nandi Hills District Hospital; Kisumu, Kenya: Kisumu West District Hospital; Mbeya, Tanzania: Mbeya Zonal Referral Hospital; Abuja, Nigeria: Defence Headquarters Medical Center; Lagos, Nigeria: 68th Nigerian Army Reference Hospital.
Figure 2.
Figure 2.
(A) Percentage of participants by number of noninfectious comorbid diseases (NCDs) and site. Shown is the distribution of NCDs by site, with the majority of participants with 0 NCDs, although this varies by site. (B) Percentage of participants with select NCDs by site . Similar to overall count of NCDs, prevalence of individual NCDs varies by site: formula image Kayunga, Uganda; formula image South Rift Valley, Kenya; formula image Kisumu West, Kenya; formula image Mbeya, Tanzania; formula image Abuja and Lagos, Nigeria. 1: elevated blood pressure (BP); systolic BP >139 or diastolic BP >89 or on hypertension medications. 2: hypercholesterolemia; cholesterol >199 or on cholesterol medications. 3: dysglycemia; fasting glucose >99 or any glucose >199 or on glucose medications. 4; renal insufficiency, glomerular filtration rate <60 by Modification of Diet in Renal Disease Study equation. 5; cognitive impairment, International HIV (human immunodeficiency virus) Dementia Scale <6 for East Africa or <7 for Nigeria. Abbreviation: NCD, noninfectious comorbid disease.
See this image and copyright information in PMC

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