TY - JOUR
T1 - Noninfectious Comorbidity in the African Cohort Study
AU - African Cohort Study Team
AU - Ake, Julie A.
AU - Polyak, Christina S.
AU - Crowell, Trevor A.
AU - Kiweewa, Francis
AU - Semwogerere, Michael
AU - Maganga, Lucas
AU - Bahemana, Emmanuel
AU - Maswai, Jonah
AU - Langat, Rither
AU - Owuoth, John
AU - Otieno, Solomon
AU - Keshinro, Babajide
AU - Esber, Allahna L.
AU - Liu, Michelle
AU - Eller, Leigh Anne
AU - Ganesan, Kavitha
AU - Parikh, Ajay P.
AU - Hamm, Tiffany E.
AU - Robb, Merlin L.
AU - Hickey, Patrick W.
AU - Valcour, Victor G.
AU - Michael, Nelson L.
AU - Falodun, O.
AU - Song, K.
AU - Milazzo, M.
AU - Zhang, C.
AU - Deshano, R.
AU - Thompson, C.
AU - Smith, G.
AU - Mebrahtu, T.
AU - Coakley, P.
AU - Lombardi, K.
AU - Imbach, M.
AU - Peel, S.
AU - Malia, J.
AU - Kroidl, A.
AU - Kroidl, I.
AU - Geldmacher, C.
AU - Kafeero, C.
AU - Nambuya, A.
AU - Tegamanyi, J.
AU - Birungi, H.
AU - Mugagga, O.
AU - Nassali, G.
AU - Wangiri, P.
AU - Nantabo, M.
AU - Nambulondo, P.
AU - Atwijuka, B.
AU - Asiimwe, A.
AU - Nabanoba, C. T.
N1 - Funding Information:
Financial support. This work was supported by the Military Infectious Disease Research Program and also conducted in collaboration with a President’s Emergency Plan for AIDS Relief–supported basic program evaluation through the US DoD and funded via a cooperative agreement (W81XWH-11-2-0174) between the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., and the US DoD. V. G.V.’s contributions were supported by the National Institute of Mental Health (K24MH098759) and the Global Brain Health Institute.
Publisher Copyright:
© 2018 Published by Oxford University Press for the Infectious Diseases Society of America 2018.
PY - 2019/8/15
Y1 - 2019/8/15
N2 - 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.
AB - 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.
KW - Africa
KW - HIV
KW - comorbidity
KW - noninfectious
UR - http://www.scopus.com/inward/record.url?scp=85078512317&partnerID=8YFLogxK
U2 - 10.1093/cid/ciy981
DO - 10.1093/cid/ciy981
M3 - Article
C2 - 30476001
AN - SCOPUS:85078512317
SN - 1058-4838
VL - 69
SP - 639
EP - 647
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 4
ER -