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Befkadu Z, Ibrahim M, Tadelle A, Tegene E. Electrocardiographic abnormalities and associated factors among HIV-infected adults on antiretroviral therapy. FRONTIERS IN REPRODUCTIVE HEALTH 2024; 6:1387464. [PMID: 39318857 PMCID: PMC11420139 DOI: 10.3389/frph.2024.1387464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 08/29/2024] [Indexed: 09/26/2024] Open
Abstract
Background Individuals living with HIV are at increased risk of developing cardiovascular diseases. This heightened vulnerability is influenced by various factors, including the direct impact of HIV infection, the side effects of HIV medications, and a higher presence of traditional cardiovascular risk factors. Detecting and managing cardiovascular diseases early in HIV-infected individuals is crucial for their overall health and well-being. Electrocardiography, a simple and non-invasive test, can provide valuable information in this regard. However, there is currently no published data on the prevalence of electrocardiographic abnormalities and the associated factors among HIV-infected adults in Ethiopia. Objectives This study was aimed at assessing the prevalence of ECG abnormalities and associated factors among HIV-infected adults on antiretroviral therapy. Methodology A hospital-based comparative cross-sectional study was conducted at Mettu Karl Specialized Hospital (MKSH), southwest Ethiopia, among 96 HIV-infected patients and 96 HIV-negative control groups. A systematic random sampling technique was used to select HIV-infected respondents, and HIV-negative respondents were purposively recruited from caregivers. A face-to-face interview with a semi-structured and pretested questionnaire was conducted to collect the socio-demographic and behavioral characteristics of the study participants. Electrocardiography was done for all study participants using a 12-lead electrocardiograph, interpreted by a cardiologist, and classified according to the Minnesota Code classification system. The data were entered into Epi-Data version 4.6 and exported to SPSS version 25 for analysis. Finally, descriptive statistics, chi-square, independent t-test, bivariable, and multivariable logistic regression analyses were done at a 5% significance level. Results The study found that 49% of HIV-infected and 19.8% of HIV-negative participants had at least one ECG abnormality. The proportion of coded ST-segment abnormalities, T-wave abnormalities, longer QT interval, and sinus tachycardia was significantly higher in HIV-infected respondents than in HIV-negatives. Being a smoker [AOR = 3.7, 95%CI: 1.03-13.6], being on Protease inhibitors [AOR = 3.6, 95%CI: 1.02-13.1] and having CD4 less than 350 cells/mm3 [AOR = 3.2, 95%CI: 1.22-8.49] were significantly associated with ECG abnormalities among HIV-infected respondents. Conclusion Compared to HIV-negative participants, HIV-infected patients had a significantly higher prevalence of ECG abnormalities. Screening for ECG abnormalities is needed for the early detection of cardiac abnormalities and the reduction of future complications.
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Affiliation(s)
- Zewudu Befkadu
- Department of Biomedical Science, College of Health Science, Mattu University, Mattu, Ethiopia
| | - Mohammed Ibrahim
- Department of Biomedical Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Amanuel Tadelle
- Department of Biomedical Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Elsah Tegene
- Department of Internal Medicine, Institute of Health, Jimma University, Jimma, Ethiopia
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Asgedom YS, Kebede TM, Gebrekidan AY, Koyira MM, Azeze GA, Lombebo AA, Efa AG, Haile KE, Kassie GA. Prevalence of metabolic syndrome among people living with human immunodeficiency virus in sub-Saharan Africa: a systematic review and meta-analysis. Sci Rep 2024; 14:11709. [PMID: 38777850 PMCID: PMC11111734 DOI: 10.1038/s41598-024-62497-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 05/17/2024] [Indexed: 05/25/2024] Open
Abstract
Metabolic syndrome (MetS) poses a significant clinical challenge for individuals living with HIV (PLHIV). In sub-Saharan Africa (SSA), this condition is becoming a growing concern, owing to lifestyle changes and an increasingly aging population. Several SSA countries have reported on the prevalence of MetS. However, these estimates may be outdated because numerous recent studies have updated MetS prevalence among PLHIV in these countries. Moreover, prior research has focused on various study designs to report the pooled prevalence, which is a methodological limitation. Therefore, this systematic review and meta-analysis aimed to determine the pooled estimates of MetS in PLHIV in SSA by addressing these gaps. We systematically searched Google Scholar, Science Direct, Scopus, Web of Sciences, EMBASE, and PubMed/Medline for the prevalence of MetS and its subcomponents among people with HIV in sub-Saharan Africa. The estimated pooled prevalence was presented using a forest plot. Egger's and Begg's rank regression tests were used to assess evidence of publication bias. Twenty-five studies fulfilled the inclusion criteria after review of the updated PRISMA guidelines. The pooled prevalence of MetS was 21.01% [95% CI: (16.50, 25.51)] and 23.42% [95% CI: (19.16, 27.08)] to the National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP III) and International Diabetes Federation (IDF) criteria, respectively. Low levels of high-density lipoprotein cholesterol (Low HDL) at 47.25% [95% CI: 34.17, 60.33)] were the highest reported individual subcomponent, followed by abdominal obesity at 38.44% [95% CI: (28.81, 48.88)]. The prevalence of MetS is high in sub-Saharan Africa. Low HDL levels and increased waist circumference/abdominal obesity were the most prevalent components of MetS. Therefore, early screening for MetS components and lifestyle modifications is required. Policymakers should develop strategies to prevent MetS before an epidemic occurs.PROSPERO: CRD42023445294.
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Belete AM, Melese DM, Bewket B, Tegegne B, Shiferaw WS, Aynalem YA, Asefa A, Yazie TS. Dyslipidemia among adult HIV patients on antiretroviral therapy and its association with age and body mass index in Ethiopia: A systematic review and meta-analysis. PLoS One 2024; 19:e0298525. [PMID: 38722964 PMCID: PMC11081291 DOI: 10.1371/journal.pone.0298525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/26/2024] [Indexed: 05/13/2024] Open
Abstract
INTRODUCTION Dyslipidemia is a common public health problem in people living with human immunodeficiency virus (HIV) who are receiving antiretroviral therapy and increases the risk of cardiovascular disease. Although evidence indicates that the prevalence of dyslipidemia is high, estimated pooled data are not well documented. Therefore, we aimed to estimate the pooled prevalence of dyslipidemia in adult people living with HIV receiving antiretroviral therapy in Ethiopia. METHOD We conducted a systematic review and meta-analysis of the literature. The following databases and grey literature were searched: PubMed, WorldCat, ScienceDirect, DOAG, African Journals Online, Google Scholar, and African Index Medicine. We included all comparative epidemiological studies that reported the prevalence of high concentration of total cholesterol, triglycerides, and low density lipoprotein, and low concentration of high density lipoprotein cholesterol that were published between January 2003 and July 2023. The random effects model was used to pool the outcome of interest. Additionally, subgrouping, sensitivity analyses, and funnel plots were performed. R software Version 4.2.1 was used for statistical analysis. RESULT Seventeen studies with a total of 3929 participants were included in the meta-analysis. The pooled prevalence of dyslipidemia, high total cholesterol, high triglyceride, elevated level of low density lipoprotein and low level of high density lipoprotein cholesterol were 69.32% (95% CI: 63.33, 74.72), 39.78% (95%CI: 32.12, 47.96), 40.32% (95%CI: 34.56, 46.36), 28.58% (95%CI: 21.81, 36.46), and 36.17% (95%CI: 28.82, 44.24), respectively. Age and body mass index were associated with high total cholesterol, triglyceride, and low-density lipoprotein cholesterol levels. CONCLUSION The authors concluded that the prevalence of dyslipidemia in Ethiopia is high in people living with HIV receiving antiretroviral therapy. Early detection of dyslipidemia and its integration into treatment are essential for preventing cardiovascular disease. TRIAL REGISTRATION Protocol registered with PROSPERO (CRD42023440125).
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Affiliation(s)
- Abebe Muche Belete
- Department of Biomedical Science, Asrat Weldyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Daniel Molla Melese
- Department of Biomedical Science, Asrat Weldyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Bekalu Bewket
- Department of Nursing, College of Health Science, Injibara University, Injibara, Ethiopia
| | - Belachew Tegegne
- Department of Nursing, College of Health Science, Injibara University, Injibara, Ethiopia
| | - Wondimeneh Shibabaw Shiferaw
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Australia
- Department of Nursing, Asrat Weldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | | | - Adisu Asefa
- Department of Non communicable disease, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Taklo Simeneh Yazie
- Department of Pharmacy, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
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Jemal M, Shibabaw Molla T, Tiruneh G. Medhin M, Chekol Abebe E, Asmamaw Dejenie T. Blood glucose level and serum lipid profiles among people living with HIV on dolutegravir-based versus efavirenz-based cART; a comparative cross-sectional study. Ann Med 2023; 55:2295435. [PMID: 38118463 PMCID: PMC10763893 DOI: 10.1080/07853890.2023.2295435] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 12/11/2023] [Indexed: 12/22/2023] Open
Abstract
BACKGROUND Antiretroviral therapy-linked metabolic abnormalities have become a growing concern among people living with HIV. There is limited data regarding the effects of dolutegravir-based treatment on blood glucose levels and serum lipid profiles in people living with HIV in Ethiopia. Thus, this study aimed to assess blood glucose levels and serum lipid profiles among people living with HIV on dolutegravir-based versus efavirenz-based therapy. METHOD AND MATERIALS An institutional-based comparative cross-sectional study was conducted from 30 June 2021 to 30 August 2021. A total of 128 participants (64 in the dolutegravir-based group and 64 in the efavirenz-based group) were enrolled in the study. The Chi-square, independent t-test, Mann-Whitney U-test, and logistic regression were used as appropriate statistical tests using SPSS Version 26.0 for this study. A p-value of <0.05 was considered statistically significant. RESULT The prevalence of hyperglycemia and dyslipidemia were 17.2% (11/64) and 79.7% (51/64) in the dolutegravir group, and 9.4% (6/64) and 75% (48/64) in the efavirenz group, respectively. The efavirenz group had significantly higher mean values of total cholesterol (190.73 ± 44.13 vs. 175.27 ± 37.67 mg/dl, p = 0.035) and high-density lipoprotein (47.53 ± 14.25 vs. 40.92 ± 13.17 mg/dl, p = 0.007) than the dolutegravir group. For a Kg/m2 increase in BMI and for each month's increase in the duration of HIV, the patients were 66% (AOR = 1.66, 95% CI: 1.13, 2.44), and 13% (AOR = 1.13, 95% CI: 1.03, 1.23) more likely to have hyperglycemia, respectively. In contrast, female patients were 3.04 times more likely to have dyslipidemia (AOR = 3.03, 95% CI: 1.14, 8.05) as compared to male patients, and with an increase in CD4 cell count of 1 cell/mm3, the odds of dyslipidemia increased by 0.3% (AOR = 1.003, 95% CI: 1.001, 1.006). CONCLUSION Efavirenz-based therapy resulted in higher mean values of total cholesterol and high-density lipoprotein as compared with dolutegravir-based therapy. It is important to consider and evaluate high-density lipoprotein levels in HIV patients on dolutegravir-based therapy, and total cholesterol levels in people living with HIV on efavirenz-based therapy.
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Affiliation(s)
- Mohammed Jemal
- Department of Biomedical Science, School of Medicine, Debre Markos University, Debre Markos, Ethiopia
| | - Tewodros Shibabaw Molla
- Department of Biochemistry, School of Medicine, College of Medicine & Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Markeshaw Tiruneh G. Medhin
- Department of Biochemistry, School of Medicine, College of Medicine & Health Sciences, University of Gondar, Gondar, Ethiopia
| | | | - Tadesse Asmamaw Dejenie
- Department of Biochemistry, School of Medicine, College of Medicine & Health Sciences, University of Gondar, Gondar, Ethiopia
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Abera W, Wube TB, Alemayehu T. The association of aspartate transaminase-to-alanine transaminase ratio and metabolic syndrome among HIV patients in Sidama Region, South Ethiopia. SAGE Open Med 2023; 11:20503121231196701. [PMID: 37694128 PMCID: PMC10483979 DOI: 10.1177/20503121231196701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/07/2023] [Indexed: 09/12/2023] Open
Abstract
Objective Studies on the association of the aspartate transaminase-to-alanine transaminase ratio with the metabolic syndrome and its components among HIV patients were scarce. This study aims to determine the association between the aspartate transaminase-to-alanine transaminase ratio and the metabolic syndrome and its components in adult HIV patients on highly active antiretroviral therapy. Methods This was a cross-sectional study conducted on 302 HIV patients from January 15 to June 30, 2021. Sociodemographic, clinical, and anthropometric data were collected using a structured questionnaire. The patient's medical records were reviewed. Biochemical analysis was performed after 5 ml of venous blood was collected from each study participant. Metabolic syndrome was defined by the third report of the national cholesterol education program-adult treatment panel. Logistic regression was done to assess the association of MetS with the independent variables, and correlation analysis was performed to see the correlation of MetS components with the aspartate aminotransferase-to-alanine aminotransferase ratio. Result 302 HIV-positive patients on highly active antiretroviral therapy were included in this study, and 54.6% were female. The median and interquartile range of the age of the study participants were 41 (35-50) years. The prevalence of metabolic syndrome was 29.5% (confidence interval = 24.5-35.1). Chronic illness (Adjusted odds ratio = 4.8, confidence interval = 2.2-10.9) and aspartate aminotransferase-to-alanine aminotransferase ratio (adjusted odds ratio = 2.5, confidence interval = 1.4-4.4) were significantly associated with Metabolic syndrome among the study participants. The aspartate aminotransferase-to-alanine aminotransferase ratio was significantly correlated with blood pressure. Conclusion This study found the existence of a significant association between the aspartate aminotransferase-to-alanine aminotransferase ratio and metabolic syndrome among HIV patients.
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Affiliation(s)
- Wondwossen Abera
- School of Medical Laboratory Science, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
| | - Temesgen Bizuayehu Wube
- School of Medical Laboratory Science, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
| | - Tsegaye Alemayehu
- School of Medical Laboratory Science, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
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Bowo-Ngandji A, Kenmoe S, Ebogo-Belobo JT, Kenfack-Momo R, Takuissu GR, Kengne-Ndé C, Mbaga DS, Tchatchouang S, Kenfack-Zanguim J, Lontuo Fogang R, Zeuko'o Menkem E, Ndzie Ondigui JL, Kame-Ngasse GI, Magoudjou-Pekam JN, Wandji Nguedjo M, Assam Assam JP, Enyegue Mandob D, Ngondi JL. Prevalence of the metabolic syndrome in African populations: A systematic review and meta-analysis. PLoS One 2023; 18:e0289155. [PMID: 37498832 PMCID: PMC10374159 DOI: 10.1371/journal.pone.0289155] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 07/12/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND The metabolic syndrome (MS) is a leading cause of death worldwide. Several studies have found MS to be prevalent in various African regions. However, no specific estimates of MS prevalence in African populations exist. The aim of this study was to estimate the overall prevalence of MS in the African populations. METHODS A systematic review was conducted in PubMed, Web of Science, Africa Index Medicus, and African Journal Online Scopus to find studies published up to the 15th of August 2022. Pooled prevalence was calculated based on six diagnostic methods. The pooled prevalence of MS was estimated using a random-effects model. Our risk of bias analysis was based on the Hoy et al. tool. A Heterogeneity (I2) assessment was performed, as well as an Egger test for publication bias. PROSPERO number CRD42021275176 was assigned to this study. RESULTS In total, 297 studies corresponding to 345 prevalence data from 29 African countries and involving 156 464 participants were included. The overall prevalence of MS in Africa was 32.4% (95% CI: 30.2-34.7) with significant heterogeneity (I2 = 98.9%; P<0.001). We obtained prevalence rates of 44.8% (95% CI: 24.8-65.7), 39.7% (95% CI: 31.7-48.1), 33.1% (95% CI: 28.5-37.8), 31.6% (95% CI: 27.8-35.6) and 29.3% (95% CI: 25.7-33) using the WHO, revised NCEP-ATP III, JIS, NCEP/ATP III and IDF definition criteria, respectively. The prevalence of MS was significantly higher in adults >18 years with 33.1% (95%CI: 30.8-35.5) compared to children <18 years with 13.3% (95%CI: 7.3-20.6) (P<0.001). MS prevalence was significantly higher in females with 36.9% (95%CI: 33.2-40.7) compared to males with 26.7% (95%CI: 23.1-30.5) (P<0.001). The prevalence of MS was highest among Type 2 diabetes patients with 66.9% (95%CI: 60.3-73.1), followed by patients with coronary artery disease with 55.2% (95%CI: 50.8-59.6) and cardiovascular diseases with 48.3% (95%CI: 33.5-63.3) (P<0.001). With 33.6% (95% CI: 28.3-39.1), the southern African region was the most affected, followed by upper-middle income economies with 35% (95% CI: 29.5-40.6). CONCLUSION This study, regardless of the definition used, reveals a high prevalence of MS in Africa, confirming the ongoing epidemiological transition in African countries. Early prevention and treatment strategies are urgently needed to reverse this trend.
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Affiliation(s)
- Arnol Bowo-Ngandji
- Department of Microbiology, The University of Yaounde I, Yaounde, Cameroon
| | - Sebastien Kenmoe
- Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
| | - Jean Thierry Ebogo-Belobo
- Institute of Medical Research and Medicinal Plants Studies, Medical Research Centre, Yaounde, Cameroon
| | - Raoul Kenfack-Momo
- Department of Biochemistry, The University of Yaounde I, Yaounde, Cameroon
| | - Guy Roussel Takuissu
- Centre for Food, Food Security and Nutrition Research, Institute of Medical Research and Medicinal Plants Studies, Yaounde, Cameroon
| | - Cyprien Kengne-Ndé
- Epidemiological Surveillance, Evaluation and Research Unit, National AIDS Control Committee, Douala, Cameroon
| | | | | | | | | | | | | | - Ginette Irma Kame-Ngasse
- Institute of Medical Research and Medicinal Plants Studies, Medical Research Centre, Yaounde, Cameroon
| | | | - Maxwell Wandji Nguedjo
- Centre for Food, Food Security and Nutrition Research, Institute of Medical Research and Medicinal Plants Studies, Yaounde, Cameroon
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Hailu Tesfaye A, Gebrehiwot M, Aragaw FM, Dessie A. Prevalence and risk factors of chronic respiratory symptoms in public and private school teachers in north-western Ethiopia: results from a multicentre cross-sectional study. BMJ Open 2023; 13:e069159. [PMID: 37045568 PMCID: PMC10106045 DOI: 10.1136/bmjopen-2022-069159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
OBJECTIVE This study aimed to investigate the prevalence and risk factors of chronic respiratory symptoms among school teachers in Gondar city, north-western Ethiopia. DESIGN A school-based cross-sectional study was conducted from April to May 2019. A self-administered British Medical Research Council Questionnaire was used to assess chronic respiratory symptoms. Data were entered into Epi Info V.7 and Stata V.14 was used for analysis. A multivariable logistic regression analysis was conducted to identify factors associated with chronic respiratory symptoms. The association was determined using adjusted OR (AOR) with a 95% CI at a value of p<0.05. SETTING The study was conducted in public and private schools in Gondar city. PARTICIPANTS A total of 822 teachers participated in this study. OUTCOME MEASURES The primary outcome is the prevalence of chronic respiratory symptoms. RESULTS The total response rate was 97.4%. The majority, 532 (64.7%) of the participants, were male. The mean age (±SD) of the respondents was 36.69 (±6.93) years. The total prevalence of chronic respiratory symptoms in the previous 12 months among teachers in Gondar city was found to be 31.14% (95% CI 27.99% to 34.43%). A family history of respiratory problems (AOR=1.90; 95% CI 1.07 to 3.37), an overweight body mass index (AOR=2.57; 95% CI 1.57 to 4.21), exposure to secondhand cigarette smoke at home (AOR=9.85; 95% CI 4.77 to 20.33), use of chalk (AOR=1.97; 95% CI 1.25 to 3.09), and failure to open windows during class (AOR=2.15; 95% CI 1.02 to 4.52) were risk factors for chronic respiratory symptoms. CONCLUSION This study concluded that the prevalence of chronic respiratory symptoms was high among teachers. Making a smoking-free zone, avoiding smoking in public places, improving the ventilation conditions of the classrooms and controlling the chalk dust are all necessary actions to take to reduce chronic respiratory symptoms.
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Affiliation(s)
- Amensisa Hailu Tesfaye
- Department of Environmental and Occupational Health and Safety,Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mulat Gebrehiwot
- Department of Environmental and Occupational Health and Safety,Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Fantu Mamo Aragaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Awrajaw Dessie
- Department of Environmental and Occupational Health and Safety,Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Girma D, Dejene H, Geleta LA, Malka ES, Tesema M, Awol M, Oyato BT. Metabolic syndrome among people living with HIV in Ethiopia: a systematic review and meta-analysis. Diabetol Metab Syndr 2023; 15:61. [PMID: 36978109 PMCID: PMC10045608 DOI: 10.1186/s13098-023-01034-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 03/18/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Human Immuno-deficiency Virus (HIV) infection and antiretroviral therapy (ART) can cause metabolic disorders such as lipodystrophy, dyslipidemia, and insulin resistance, all of which are symptoms of metabolic syndrome (MetS). In Ethiopia, despite the existence of the primary studies, there was no pooled study conducted to summarize the country-level MetS among people living with HIV (PLHIV). Therefore, this study aims to estimate the pooled prevalence of MetS among PLHIV in Ethiopia. METHODS A systematic search was conducted to retrieve studies on the prevalence of MetS among PLHIV in Ethiopia from PubMed, Google Scholar, Science Direct, Web of Sciences, HINARI, and other relevant sources. A random-effects model was used to estimate the MetS in this study. The overall variation between studies was checked by the heterogeneity test (I2). The Joanna Briggs Institute (JBI) quality appraisal criteria were used to assess the quality of the studies. The summary estimates were presented with forest plots and tables. Publication bias was checked with the funnel plot and Egger's regression test. RESULTS Overall, 366 articles were identified and evaluated using the PRISMA guidelines, with 10 studies meeting the inclusion criteria included in the final analysis. The pooled prevalence of MetS among PLHIV in Ethiopia was 21.7% (95% CI:19.36-24.04) using National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP III) and 29.91% (95% CI: 21.54-38.28) using International Diabetes Federation (IDF) criteria. The lowest and highest prevalence of MetS were 19.14% (95%CI: 15.63-22.64) and 25.6% (95%CI: 20.18-31.08) at Southern Nation and Nationality People Region (SNNPR) and Addis Ababa, respectively. There was no statistical evidence of publication bias in both NCEP-ATP III and IDF pooled estimates. CONCLUSION MetS was common among PLHIV in Ethiopia. Therefore, optimizing regular screening for MetS components and promoting a healthy lifestyle is suggested for PLHIV. Furthermore, more study is contributory to identify the barriers to implementing planned interventions and meeting recommended treatment goals. TRIAL REGISTRATION The review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO): CRD42023403786.
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Affiliation(s)
- Derara Girma
- Public Health Department, College of Health Sciences, Salale University, Fiche, Ethiopia
| | - Hiwot Dejene
- Public Health Department, College of Health Sciences, Salale University, Fiche, Ethiopia
| | - Leta Adugna Geleta
- Public Health Department, College of Health Sciences, Salale University, Fiche, Ethiopia
| | - Erean Shigign Malka
- Public Health Department, College of Health Sciences, Salale University, Fiche, Ethiopia
| | - Mengistu Tesema
- Public Health Department, College of Health Sciences, Salale University, Fiche, Ethiopia
| | - Mukemil Awol
- Department of Midwifery, College of health sciences, Salale University, Fiche, Ethiopia
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Metabolic Syndrome and Combination Antiretroviral Therapy in HIV Patients in Periurban Hospital in Ghana: A Case-Control Study. AIDS Res Treat 2023; 2023:1566001. [PMID: 36846379 PMCID: PMC9957619 DOI: 10.1155/2023/1566001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 01/09/2023] [Accepted: 01/20/2023] [Indexed: 02/19/2023] Open
Abstract
Background There is an increasing prevalence of cardiovascular diseases (CVDs) and risk factors in HIV patients as the levels of AIDS-related mortality and morbidity decrease. Metabolic syndrome (MetS) is the accumulation of various CVD risk factors that predict the occurrence of CVDs. We investigated the prevalence of MetS and associated risk factors in HIV patients treated with combination antiretroviral therapy (cART), cART-naïve HIV patients, and non-HIV controls. Methods In a case-control design, 158 cART-treated HIV patients, 150 cART-naïve HIV patients, and 156 non-HIV controls were recruited from a periurban hospital in Ghana. A structured questionnaire was used to collect data on demography, lifestyle, and medication. Anthropometric indices and blood pressure were measured. Fasting blood samples were collected to measure the plasma levels of glucose, lipid profile, and CD4+ cells. The presence of MetS was defined using the joint scientific statement criteria. Results The prevalence of MetS was higher in cART-treated HIV patients compared with cART-naïve HIV patients and non-HIV controls (57.3% vs. 23.6% vs. 19.2% and p < 0.001, respectively). MetS was associated with cART-treated HIV patients (odds ratio (95% CI) = 7.24 (3.41-15.39) and p < 0.001), cART-naïve HIV patients (2.04 (1.01-4.15), p=0.048), and female gender (2.42 (1.39-4.23) and p=0.002). In cART-treated HIV patients, those on zidovudine (AZT)-based regimens were associated with increased likelihood (3.95 (1.49-10.43) and p < 0.006), while those on tenofovir (TDF)-based had decreased likelihood (0.32 (0.13-0.8) and p=0.015) of having MetS. Conclusion In our study population, there was a high prevalence of MetS in cART-treated HIV patients compared to cART-naïve HIV patients and non-HIV controls. HIV patients on AZT-based regimens had an increased likelihood of having MetS, while those on TDF-based regimens had a reduced likelihood of having MetS.
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Geto Z, Challa F, Lejisa T, Getahun T, Sileshi M, Nagasa B, Tolcha Y, Daniel Y, Getnet M, Molla MD, Degef M, Bekele A, Seifu D. Cardiometabolic syndrome and associated factors among Ethiopian public servants, Addis Ababa, Ethiopia. Sci Rep 2021; 11:20635. [PMID: 34667235 PMCID: PMC8526710 DOI: 10.1038/s41598-021-99913-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 10/01/2021] [Indexed: 11/08/2022] Open
Abstract
Non-communicable diseases (NCDs) are increasingly becoming the global cause of premature death encompassing cardiovascular diseases (CVDs), cancer, respiratory diseases and diabetes mellitus. However, cardiometabolic risk factors in the general population, especially among the high-risk groups have rarely been assessed in Ethiopia. The study aimed to assess the prevalence of metabolic syndrome, its components and associated factors among staff in the Ethiopian Public Health Institute (EPHI). An institutional-based cross-section study was conducted from March to June 2018 among EPHI staff members. A total of 450 study participants were involved in the study, and the World Health Organization NCD STEPS survey instrument version 3.1 was used for the assessment. The biochemical parameters were analyzed by using COBAS 6000 analyzer. Statistical package for the social science (SPSS) version 20 was used for data analysis. Both bivariate and multivariate logistic regression analyses were used to identify associated risk factors. p value < 0.05 was considered for statistical significance. The overall prevalence of metabolic syndrome was 27.6% and 16.7% according to IDF and NCEP criteria respectively, with males having greater prevalence than females (35.8% vs 19.4%). Central obesity, low high-density lipoprotein (HDL) and hypertension had a prevalence of 80.2%, 41.3%, and 23.6%, respectively. In multivariate analysis increasing age and having a higher body mass index (25-29.9) were significantly associated with metabolic syndromes. The magnitude of metabolic syndrome was relatively high among public employees. Preventive intervention measures should be designed on the modification of lifestyle, nutrition and physical activities, and early screening for early identification of cardiometabolic risks factors should be practised to reduce the risk of developing cardiovascular diseases.
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Affiliation(s)
- Zeleke Geto
- Department of Biomedical Science, College of Medicine and Health Sciences, Wollo University, Wollo, Dessie, Ethiopia.
- National Reference Laboratory for Clinical Chemistry, Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
| | - Feyissa Challa
- National Reference Laboratory for Clinical Chemistry, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Tadesse Lejisa
- National Reference Laboratory for Clinical Chemistry, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Tigist Getahun
- National Reference Laboratory for Clinical Chemistry, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Meron Sileshi
- National Reference Laboratory for Clinical Chemistry, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Bikila Nagasa
- National Reference Laboratory for Clinical Chemistry, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Yosef Tolcha
- National Reference Laboratory for Clinical Chemistry, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Yeabkal Daniel
- National Reference Laboratory for Clinical Chemistry, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Misrak Getnet
- Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Meseret Derbew Molla
- Department of Biochemistry, College of Health Sciences, University of Gondar, Gondor, Ethiopia
| | - Maria Degef
- Department of Biochemistry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abebe Bekele
- Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Daniel Seifu
- Department of Biochemistry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Division of Basic Sciences, Department of Biochemistry, University of Global Health Equity, Kigali, Rwanda
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11
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Magnitude, components and predictors of metabolic syndrome in Northern Ethiopia: Evidences from regional NCDs STEPS survey, 2016. PLoS One 2021; 16:e0253317. [PMID: 34153079 PMCID: PMC8216523 DOI: 10.1371/journal.pone.0253317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/02/2021] [Indexed: 11/19/2022] Open
Abstract
Background Individuals with metabolic syndrome are five times more susceptible to chronic diseases. Assessment of its magnitude, components, and risk factors is essentials to deploy visible interventions needed to avoid further complications. The study aimed to assess magnitude, components, and predictors of metabolic syndrome in Tigray region northern Ethiopia, 2016. Methods Data were reviewed from Tigray region NCDs STEPs survey data base between May to June 2016. A total of 1476 adults aged 18–64 years were enrolled for the study. Multi-variable regression analysis was performed to estimate the net effect of size to risk factors associated with metabolic syndrome. Statistical significance was declared at p-value of ≤0.05 at 95% confidence interval (CI) for an adjusted odds ratio (AOR). Results The study revealed that unadjusted and adjusted prevalence rate of Metabolic Syndrome (MetS) were (CPR = 33.79%; 95%CI: 31.29%–36.36%) and (APR = 34.2%; 95% CI: 30.31%–38.06%) respectively. The most prevalent MetS component was low HDL concentration (CPR = 70.91%; 95%CI: 68.47%–73.27%) and (APR = 70.61; 95%CI; 67.17–74.05). While; high fasting blood glucose (CPR = 20.01% (95%CI: 18.03–22.12) and (APR = 21.72; 95%CI; 18.41–25.03) was the least ones. Eating vegetables four days a week, (AOR = 3.69, 95%CI; 1.33–10.22), a salt sauce added in the food some times (AOR = 5.06, 95%CI; 2.07–12.34), overweight (AOR = 24.28, 95%CI; 10.08–58.47] and obesity (AOR = 38.81; 12.20–111.04) had strong association with MetS. Conclusion The magnitude of metabolic syndrome was found to be close to the national estimate. Community awareness on life style modification based on identified MetS components and risk factors is needed to avoid further complications.
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Jemere T, Kefale B. Metabolic syndrome and its associated factors in Ethiopia: A systematic review and meta-analysis. J Diabetes Metab Disord 2021; 20:1021-1031. [PMID: 34222097 PMCID: PMC8212201 DOI: 10.1007/s40200-021-00815-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 05/02/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Metabolic syndrome (MetS) is a common complex entity that has emerged as a worldwide epidemic and major public health concern. The incidence of MetS often parallels the incidence of obesity and it is even worst among people living with comorbidities like; HIV/AIDS, hypertension, and mental illness. Therefore, there was an urgent need to summarize the extent and risk factors of MetS in Ethiopia. METHODOLOGY This systematic review was conducted according to the PRISMA guideline to investigate the prevalence of MetS and contributing factors. English language-based databases (PubMed, Cumulative Index to Nursing and Allied Health Literature, EMBASE, and Cochrane library) were exhaustively searched to identify studies related to the prevalence of MetS. A random-effects model was employed to estimate the pooled prevalence of MetS, and it was computed using STATA 16.0 software. Heterogeneity analysis was reported using I2. RESULT A total of 25 studies with 21,431 study participants were included for this systematic review and meta-analysis. The pooled prevalence of MetS was 30.0% (95% CI: 24.0-36.0%, I2 = 99.19%, p < 0.001) with a high degree of heterogeneity across studies. Subgroup analysis with the target population showed that metabolic syndrome was most prevalent among type II diabetic 56% (95% CI: 47 - 64) and hypertensive patients 44% (95% CI: 35 - 53). Increased age, female gender, being overweight and obese, having a high educational level and income, physical inactivity, and being on treatment of chronic diseases like, diabetes mellitus, hypertension and HIV/AIDS were the most frequently reported risk factors of MetS regardless of the study population. CONCLUSION The prevalence of the MetS is high and rising in Ethiopia. Therefore, the preventative strategy should be considered to reduce the risk of morbidity or mortality related to metabolic syndrome.
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Affiliation(s)
- Tadeg Jemere
- Physiology Unit and Research Team, Department of Biomedical Sciences, College of Health Sciences, Debre Tabor University, PO Box 272, Debre Tabor, Amhara, Ethiopia
| | - Belayneh Kefale
- Clinical Pharmacy Unit and Research Team, Department of Pharmacy, College of Health Sciences, Debre Tabor University, PO Box 272, Debre Tabor, Amhara, Ethiopia
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13
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Hamooya BM, Mulenga LB, Masenga SK, Fwemba I, Chirwa L, Siwingwa M, Halwiindi H, Koethe JR, Lipworth L, Heimburger DC, Musonda P, Mutale W. Metabolic syndrome in Zambian adults with human immunodeficiency virus on antiretroviral therapy: Prevalence and associated factors. Medicine (Baltimore) 2021; 100:e25236. [PMID: 33832083 PMCID: PMC8036111 DOI: 10.1097/md.0000000000025236] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 02/25/2021] [Indexed: 01/05/2023] Open
Abstract
Metabolic syndrome (MetS) is a constellation of factors including hypertension, abdominal obesity, dyslipidemia, and insulin resistance that separately and together significantly increase risk for cardiovascular disease (CVD) and diabetes. In sub-Saharan Africa, with a substantial burden of human immunodeficiency virus (HIV) and increasing prevalence of CVD and diabetes, there is a paucity of epidemiological data on demographic, laboratory, and clinical characteristics associated with MetS among people with HIV (people with human [PWH]). Therefore, this study aimed to determine the burden and factors influencing MetS in antiretroviral therapy (ART)-experienced individuals in Zambia.We collected cross-sectional demographic, lifestyle, anthropometric, clinical, and laboratory data in a cohort of ART-experienced (on ART for ≥6 months) adults in 24 urban HIV treatment clinics of Zambia between August, 2016 and May, 2020. MetS was defined as having ≥3 of the following characteristics: low high density lipoprotein cholesterol (HDL-c) (<1.0 mmol/L for men, <1.3 for women), elevated waist circumference (≥94 cm for men, ≥80 cm for women), elevated triglycerides (≥1.7 mmol/L), elevated fasting blood glucose (≥5.6 mmol/L), and elevated blood pressure (BP) (systolic BP ≥130 or diastolic BP ≥85 mm Hg). Virological failure (VF) was defined as HIV viral load ≥1000 copies/mL. The following statistical methods were used: Chi-square test, Wilcoxon rank-sum test, and multivariable logistic regression.Among 1108 participants, the median age (interquartile range [IQR]) was 41 years (34, 49); 666 (60.1%) were females. The prevalence of MetS was 26.3% (95% confidence interval [CI] 23.9-29.1). Age (adjusted odds ratio [OR] 1.07; 95% CI 1.04-1.11), female sex (OR 3.02; 95% CI 1.55-5.91), VF (OR 1.98; 95% CI 1.01-3.87), dolutegravir (DTG)-based regimen (OR 2.10; 95% CI 1.05-4.20), hip-circumference (OR 1.03; 95% CI 1.01-1.05), T-lymphocyte count (OR 2.23; 95% CI 1.44-3.43), high-sensitivity C-reactive protein (hsCRP) (OR 1.14; 95% CI 1.01-1.29), and fasting insulin (OR 1.02; 95% CI 1.01-1.04) were significantly associated with MetS.Metabolic syndrome was highly prevalent among HIV+ adults receiving ART in Zambia and associated with demographic, clinical, anthropometric, and inflammatory characteristics. The association between MetS and dolutegravir requires further investigation, as does elucidation of the impact of MetS on ART outcomes in sub-Saharan African PWH.
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Affiliation(s)
- Benson M. Hamooya
- University of Zambia School of Public Health
- Mulungushi University School of Medicine and Health Sciences, Livingstone
- Vanderbilt Institute for Global Health
| | - Lloyd B. Mulenga
- Ministry of Health
- University of Zambia School of Medicine, Lusaka, Zambia
- University Teaching Hospital, Adult Infectious Disease Center, Zambia
| | - Sepiso K. Masenga
- Mulungushi University School of Medicine and Health Sciences, Livingstone
- Vanderbilt Institute for Global Health
- Department of Biomedical Sciences, University of Zambia School of Health Sciences, Lusaka
| | | | - Lameck Chirwa
- University Teaching Hospital, Adult Infectious Disease Center, Zambia
| | - Mpanji Siwingwa
- University Teaching Hospital, Adult Infectious Disease Center, Zambia
| | | | - John R. Koethe
- Vanderbilt Institute for Global Health
- Vanderbilt University Medical Center Nashville, Tennessee
| | - Loren Lipworth
- Vanderbilt University Medical Center Nashville, Tennessee
| | - Douglas C. Heimburger
- Vanderbilt Institute for Global Health
- University of Zambia School of Medicine, Lusaka, Zambia
- Vanderbilt University Medical Center Nashville, Tennessee
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14
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Amare H, Olsen MF, Friis H, Andersen ÅB, Abdissa A, Yilma D, Girma T, Faurholt-Jepsen D. Predictors of glucose metabolism and blood pressure among Ethiopian individuals with HIV/AIDS after one-year of antiretroviral therapy. Trop Med Int Health 2021; 26:428-434. [PMID: 33405245 DOI: 10.1111/tmi.13544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Better understanding of glucose metabolism in patients with HIV after initiating antiretroviral therapy (ART) is important to target treatment and follow-up for diabetes risk and other non-communicable diseases in resource-limited settings. The aim of this study was to assess the changes and predictors of glucose metabolism and blood pressure among patients with HIV on ART for 12 months. METHODS One-year follow-up of Ethiopian patients with HIV after initiation of ART was done. Outcomes were changes in fasting plasma glucose (FPG), and 30-minute (30mPG) and 2-hour plasma glucose (2hPG) after oral glucose tolerance test, glycated haemoglobin (HbA1c), fasting plasma insulin (p-insulin), homeostatic model assessment index for insulin resistance (HOMA-IR) and blood pressure. RESULTS: The mean age was 33 years, and the majority were women. During the first 12 months, levels of all plasma glucose parameters decreased, while p-insulin (10B 3.1; 95% CI2.4, 4.0), HOMA-IR (10B 3.1; 95% CI2.3, 4.0) and systolic blood pressure (B 4.0; 95% CI2.5, 5.5) increased. Fat-free mass at baseline predicted higher increments in p-insulin, HOMA-IR and blood pressure; whereas, fat mass predicted higher increment in HbA1c. CONCLUSIONS Among Ethiopian patients with HIV, blood pressure and insulin increased, and all glucose parameters declined during 12-month of ART. Only longer-term follow-up will tell us whether insulin increase is due to insulin resistance or from recovering β-cells.
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Affiliation(s)
- Hiwot Amare
- Department of Internal Medicine, Jimma University, Jimma, Ethiopia.,JUCAN Research Centre, Jimma University, Jimma, Ethiopia
| | - Mette F Olsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Åse B Andersen
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Alemseged Abdissa
- JUCAN Research Centre, Jimma University, Jimma, Ethiopia.,Department of Laboratory Sciences, Jimma University, Jimma, Ethiopia
| | - Daniel Yilma
- Department of Internal Medicine, Jimma University, Jimma, Ethiopia.,JUCAN Research Centre, Jimma University, Jimma, Ethiopia
| | - Tsinuel Girma
- JUCAN Research Centre, Jimma University, Jimma, Ethiopia.,Department of Paediatrics and Child Health, Jimma University, Jimma, Ethiopia
| | - Daniel Faurholt-Jepsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark.,Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
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15
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Muche Belete A, Seifu D, Menon M, Amogne W, Shewa A, Adela Tefera A. Serum Lipid Profiles of Patients Taking Efavirenz-Based Antiretroviral Regimen Compared to Ritonavir-Boosted Atazanavir with an Optimized Background at Zewditu Memorial Hospital, Addis Ababa, Ethiopia. HIV AIDS (Auckl) 2021; 13:217-227. [PMID: 33642881 PMCID: PMC7903961 DOI: 10.2147/hiv.s296170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/11/2021] [Indexed: 01/11/2023] Open
Abstract
Background Dyslipidemia represents significant health care concerns in patients taking antiretroviral therapy due to their association with cardiovascular disease risk. There is limited data regarding the effects of boosted atazanavir (ATV/r) treatment in the lipid profiles of Ethiopian HIV patients. Thus, this study compares the mean values of lipid profile differences of HIV patients on ATV/r-based regimen compared to efavirenz (EFV)-based regimen, while the background is Tenofovir Disoproxil Fumarate/lamivudine. Materials and Methods A comparative hospital-based cross-sectional study was conducted among adult HIV-infected patients at Zewditu Memorial Hospital, Addis Ababa, Ethiopia, from July–September 2017. An equal number of EFV and ATV/r-treated patients (n=90 each) receiving for 1-year and over were included in the study. Serum total cholesterol (TC), triglyceride (TG), gigh-density lipoprotein cholesterol (HDL-c), and low-density lipoprotein cholesterol (LDL-c) were measured. Data comparison used chi-square test, Student’s t-test and Mann–Whitney U-test. Multivariate logistic regression analysis and p-value<0.05 were used to identify associated factors of serum lipid profiles. Results In the present study, the ATV/r-treated group results were significantly higher in the median values of TG [207 (56–1094) vs 145 (42–768) mg/dL; p=0.001] and the mean value of TG/HDL-c (6.6 vs 4.4; p=0.001) as compared to the EFV-treated group. The EFV-treated group showed significantly higher in the mean value of HDL-c (44.7 vs 38.7 mg/dL; p=0.001) as compared to the ATV/r-treated group. Body mass index was associate with LDL and HDL. CD4 was associated with TC. Current antiretroviral therapy was associated with TG. Duration of HIV since first diagnosis and duration of ART were associated with HDL. Conclusion ATV/r is associated with elevated in TG and TG/HDL-C, but low HDL as compared to EFV. Differences in LDL or HDL that were found were of unclear clinical significance. The long-term significance is unknown.
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Affiliation(s)
- Abebe Muche Belete
- Department of Biochemistry, Medical Faculty, Debre Berhan University, Debre Berhan, Ethiopia
- Correspondence: Abebe Muche Belete Department of Biochemistry, Medical Faculty, Debre Berhan University, P.O. Box 445, Debre Berhan, Ethiopia Email
| | - Daniel Seifu
- Department of Biochemistry, Division of Biomedical Sciences, University of Global Health Equity, Kigali, Rwanda
| | - Menakath Menon
- Department of Biochemistry, Medical Faculty, Addis Ababa University, Addis Ababa, Ethiopia
| | - Wondwossen Amogne
- Department of Internal Medicine, Medical Faculty, Addis Ababa University, Addis Ababa, Ethiopia
| | - Aster Shewa
- Department of Internal Medicine, Zewditu Memorial Hospital, Addis Ababa, Ethiopia
| | - Alemu Adela Tefera
- Department of Biochemistry, Medical Faculty, Debre Berhan University, Debre Berhan, Ethiopia
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Aouam A, Marmouch H, Kooli I, Marrakchi W, Hellara I, Neffati F, Najjar F, Chakroun M. [Metabolic syndrome among people with HIV in central Tunisia: Prevalence and associated factors]. ANNALES PHARMACEUTIQUES FRANÇAISES 2021; 79:465-472. [PMID: 33516719 DOI: 10.1016/j.pharma.2021.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/28/2020] [Accepted: 01/15/2021] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Metabolic abnormalities are frequently reported in HIV infection. They were mainly related to the chronic infection and the use of antiretroviral therapy. OBJECTIVE Describe the epidemiological, clinical, laboratory and treatment features of people living with HIV (PLHIV) on antiretroviral therapy and determine the prevalence of metabolic syndrome and its associated factors. MATERIALS AND METHODS We conducted a cross-sectional, descriptive and analytical study in the service of Infectious Diseases of the University Hospital of Monastir. We included all PLHIV on antiretroviral therapy for at least 3 months. Biological explorations based on metabolic parameters were performed systematically for all patients after informed consent. Metabolic syndrome was assessed according to the definitions of the International Diabetes Federation (IDF) in 2005. We divided the patients into two groups: Group A: PLHIV with metabolic syndrome (n=19) and Group B: PLHIV without metabolic syndrome (n=51). RESULTS We included in this study 70 PLVIH. The metabolic syndrome was noted in 19 cases (27.1%). The average age was 43.7 years in group A and 36.7 years in group B. Gender distribution were uniform in the two groups (P=0.4). HIV infection has been evolving for 9.7 and 5.8 years respectively in group A and B, P=0.017. Body mass index (BMI) was significantly higher in group A (26.4 vs 23.5kg/m2, P=0.008). Two patients in group A (10.5%) and 14 patients in group B (27.4%) had a low CD4 count (<200/mm3). Protease inhibitor regimens were prescribed in five cases (26.3%) in group A and 26 cases (50.9%) in group B. In multivariate models, Age over 40 (OR=9.9, 95% CI 2.4-40.6, P=0.001) and BMI ≥25 Kg/m2 (OR=8.47, 95% CI 1.94-36.8, p=0.004) were both independently associated with the presence of the metabolic syndrome. CONCLUSION Metabolic syndrome is common among PLHIV on antiretroviral therapy. The identification of factors associated is a main parameter for early detection of metabolic risk and personalized management.
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Affiliation(s)
- A Aouam
- Service des Maladies Infectieuses, EPS Fattouma Bourguiba, 5019 Monastir, Tunisie.
| | - H Marmouch
- Service d'endocrinologie et de médecine interne, EPS Fattouma Bourguiba, 5019 Monastir, Tunisie.
| | - I Kooli
- Service des Maladies Infectieuses, EPS Fattouma Bourguiba, 5019 Monastir, Tunisie.
| | - W Marrakchi
- Service des Maladies Infectieuses, EPS Fattouma Bourguiba, 5019 Monastir, Tunisie.
| | - I Hellara
- Laboratoire de biochimie, EPS Fattouma Bourguiba, 5019 Monastir, Tunisie.
| | - F Neffati
- Laboratoire de biochimie, EPS Fattouma Bourguiba, 5019 Monastir, Tunisie.
| | - F Najjar
- Laboratoire de biochimie, EPS Fattouma Bourguiba, 5019 Monastir, Tunisie.
| | - M Chakroun
- Service des Maladies Infectieuses, EPS Fattouma Bourguiba, 5019 Monastir, Tunisie.
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Rwegerera GM, Shailemo DHP, Pina Rivera Y, Mokgosi KO, Bale P, Oyewo TA, Luis BD, Habte D, Godman B. Metabolic Control and Determinants Among HIV-Infected Type 2 Diabetes Mellitus Patients Attending a Tertiary Clinic in Botswana. Diabetes Metab Syndr Obes 2021; 14:85-97. [PMID: 33469326 PMCID: PMC7810972 DOI: 10.2147/dmso.s285720] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 11/19/2020] [Indexed: 12/15/2022] Open
Abstract
PURPOSE We primarily aimed at determining the prevalence of metabolic syndrome and abnormal individual metabolic control variables in HIV-infected participants as compared to HIV-uninfected participants given current concerns. Our secondary objective was to determine the predictors of metabolic syndrome and individual metabolic control variables among the study participants to guide future management. PATIENTS AND METHODS A descriptive, case-matched cross-sectional study for four months from 15th June 2019 to 15th October 2019 at Block 6 Diabetes Reference Clinic in Gaborone, Botswana. We compared the proportions of metabolic syndrome and individual metabolic control variables based on gender and HIV status by means of bivariate analysis (Chi-squared test or Fisher's exact test) to determine factors associated with metabolic control. A p-value of less than 0.05 was considered statistically significant. RESULTS Overall, 86% of the study participants were found to have metabolic syndrome by International Diabetes Federation (IDF) criteria with 79.8% among HIV-infected and 89.1% among HIV-negative participants (p-value = 0.018). Older age was significantly associated with metabolic syndrome (p-value = 0.008). Female gender was significantly associated with metabolic syndrome as compared to male gender (P-value < 0.001), and with a statistically significant higher proportion of low HDL-C compared to males (P-value < 0.001). Female participants were significantly more likely to be obese as compared to males (P-value < 0.001). High triglycerides were more common in HIV-infected compared to HIV-negative participants (P-value = 0.004). HIV-negative participants were more likely to be obese as compared to HIV-infected participants (P-value = 0.003). CONCLUSION Metabolic syndrome is an appreciable problem in this tertiary clinic in Botswana for both HIV-infected and HIV-negative participants. Future prospective studies are warranted in our setting and similar sub-Saharan settings to enhance understanding of the role played by HAART in causing the metabolic syndrome, and the implications for future patient management.
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Affiliation(s)
- Godfrey Mutashambara Rwegerera
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Department of Medicine, Princess Marina Hospital, Gaborone, Botswana
| | - Dorothea H P Shailemo
- Department of Pharmacology and Therapeutics, School of Pharmacy, University of Namibia, Windhoek, Namibia
| | | | - Kathryn O Mokgosi
- Department of Obstetrics and Gynaecology, Nyangabgwe Referral Hospital, Francistown, Botswana
| | - Portia Bale
- Otse Outpatient Clinic, District Health Management Team, Lobatse, Botswana
| | - Taibat Aderonke Oyewo
- Department of Medicine, Princess Marina Hospital, Gaborone, Botswana
- Department of Family Medicine, University of Botswana, Gaborone, Botswana
| | - Bruno Diaz Luis
- Department of Medicine, Princess Marina Hospital, Gaborone, Botswana
| | - Dereje Habte
- Consultant Public Health Specialist, Addis Ababa, Ethiopia
| | - Brian Godman
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria0208, South Africa
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, GlasgowG4 0RE, UK
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
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Kabthymer RH, Nega Techane S, Muche T, Ali Ewune H, Mekonnen Abate S, Feyisso Shaka M. Overweight and Obesity Among Adult HIV Infected Peoples Receiving ART in Ethiopia: A Systematic Review and Meta-Analysis. J Prim Care Community Health 2021; 12:2150132721993647. [PMID: 33543684 PMCID: PMC7874346 DOI: 10.1177/2150132721993647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/07/2021] [Accepted: 01/09/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Over-nutrition and diet-linked non-communicable morbidities are showing increasing trend overtime. Even if there are different factors that affect the change in BMI other than ART, several authors have reported increases in BMI among PLHIV on treatment that are equal to or surpass the general population. This study is aimed to estimate the prevalence of obesity and overweight among adult HIV infected peoples taking ART in Ethiopia. METHOD PubMed, CINAHL, Web of science, global health and Google scholar electronic databases were used to perform a systematic literature search. Two authors independently extracted all the necessary data using a structured data extraction format. Data analysis was done using STATA Version 14. The heterogeneity of the studies was assessed by using I2 test. A random-effects model was used to estimate the pooled prevalence. Publication bias was checked using Funnel plot and Egger's test. RESULT Two thousand seven hundred and fifty-one studies were reviewed and 13 studies fulfilling the inclusion criteria were included in the meta-analysis. The meta-analysis of 13 studies, comprising 4994 participants resulted in pooled prevalence of overweight to be 17.85% (95% CI: 12.22-23.47). Whereas, the pooled prevalence of overweight was found to be 3.90 (95% CI: 2.31-5.49) but after adjusting for publication bias using trim and fill analysis it has become 3.58 (95% CI: 2.04-5.13). Magnitude of both overweight and obesity was higher in studies conducted in Addis Ababa, studies done after 2016 and studies having sample size of less than 400, in subgroup analysis. CONCLUSION The magnitude of overweight and obesity among HIV infected peoples taking ART in Ethiopia is high. There is a need to have a routine screening to PLWHA on the risk of over-nutrition in order to facilitate early detection.
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Affiliation(s)
| | | | - Temesgen Muche
- College of health sciences and medicine, Dilla University, Dilla, Ethiopia
| | - Helen Ali Ewune
- College of health sciences and medicine, Dilla University, Dilla, Ethiopia
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Ambachew S, Endalamaw A, Worede A, Tegegne Y, Melku M, Biadgo B. The Prevalence of Metabolic Syndrome in Ethiopian Population: A Systematic Review and Meta-analysis. J Obes 2020; 2020:2701309. [PMID: 33489358 PMCID: PMC7803160 DOI: 10.1155/2020/2701309] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 11/05/2020] [Accepted: 11/30/2020] [Indexed: 01/02/2023] Open
Abstract
Background The metabolic syndrome is a clustering of hyperglycemia/insulin resistance, hypertension, dyslipidemia, and obesity which are risk factors for cardiovascular disease, type 2 diabetes and stroke, and all-cause mortality. The burden of metabolic syndrome is emerging alarmingly in low- and middle-income countries such as Ethiopia; however, there is lack of comprehensive estimation. This study aimed to determine the pooled prevalence of metabolic syndrome in Ethiopia. Methods This systematic review and meta-analysis included original articles of observational studies published in the English language. Searches were carried out in PubMed, Google Scholar, and Africa Journals from conception to August 2020. A random-effects model was used to estimate the pooled prevalence of metabolic syndrome in Ethiopia. Heterogeneity was assessed using the I 2 statistic. Subgroup analysis was also conducted based on sex/gender and study subjects. Egger's test was used to assess publication bias. Results Electronic and gray literature search retrieved 942 potentially relevant papers. After removing duplicates and screening with eligibility criteria, twenty-eight cross-sectional studies were included in this meta-analysis. The pooled prevalence of metabolic syndrome in Ethiopia was found to be 34.89% (95% CI: 26.77, 43.01) and 27.92% (95% CI: 21.32, 34.51) by using NCEP/ATP III and IDF criteria, respectively. The weighted pooled prevalence of metabolic syndrome was higher in females 36.74% (95% CI: 20.72, 52.75) and 34.09% (95% CI: 26.68, 41.50) compared to males 22.22% (95% CI: 14.89, 29.56) and 24.82% (95% CI: 18.34, 31.31) by using IDF and NCEP/ATP III criteria, respectively. Subgroup analysis based on the study subjects using NCEP/ATP III showed that the weighted pooled prevalence was 63.78%(95% CI: 56.17, 71.40), 44.55% (95% CI: 30.71, 52.38), 23.09% (95% CI: 19.74, 26.45), 20.83% (95% CI: 18.64, 23.01), and 18.45% (95% CI: 13.89, 23.01) among type 2 diabetes patients, hypertensive patients, psychiatric patients, HIV patients on HAART, and working adults, respectively. The most frequent metabolic syndrome components were low HDL-C 51.0% (95% CI: 42.4, 59.7) and hypertriglyceridemia 39.7% (95% CI: 32.8, 46.6). Conclusions The findings revealed an emerging high prevalence of metabolic syndrome in Ethiopia. Therefore, early intervention is required for the primary prevention of the occurrence of metabolic syndrome and the further reduction of the morbidity and mortality related to it.
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Affiliation(s)
- Sintayehu Ambachew
- Department of Clinical Chemistry, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Aklilu Endalamaw
- Departement of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Abebaw Worede
- Department of Clinical Chemistry, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yalewayker Tegegne
- Department of Parasitology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mulugeta Melku
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Belete Biadgo
- Department of Clinical Chemistry, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Amponsah-Dacosta E, Tchuem CT, Anderson M. Chronic hepatitis B-associated liver disease in the context of human immunodeficiency virus co-infection and underlying metabolic syndrome. World J Virol 2020; 9:54-66. [PMID: 33362998 PMCID: PMC7747023 DOI: 10.5501/wjv.v9.i5.54] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/24/2020] [Accepted: 10/12/2020] [Indexed: 02/06/2023] Open
Abstract
Globally, a shift in the epidemiology of chronic liver disease has been observed. This has been mainly driven by a marked decline in the prevalence of chronic hepatitis B virus infection (CHB), with the greatest burden restricted to the Western Pacific and sub-Saharan African regions. Amidst this is a growing burden of metabolic syndrome (MetS) worldwide. A disproportionate co-burden of human immunodeficiency virus (HIV) infection is also reported in sub-Saharan Africa, which poses a further risk of liver-related morbidity and mortality in the region. We reviewed the existing evidence base to improve current understanding of the effect of underlying MetS on the development and progression of chronic liver disease during CHB and HIV co-infection. While the mechanistic association between CHB and MetS remains poorly resolved, the evidence suggests that MetS may have an additive effect on the liver damage caused by CHB. Among HIV infected individuals, MetS-associated liver disease is emerging as an important cause of non-AIDS related morbidity and mortality despite antiretroviral therapy (ART). It is plausible that underlying MetS may lead to adverse outcomes among those with concomitant CHB and HIV co-infection. However, this remains to be explored through rigorous longitudinal studies, especially in sub-Saharan Africa. Ultimately, there is a need for a comprehensive package of care that integrates ART programs with routine screening for MetS and promotion of lifestyle modification to ensure an improved quality of life among CHB and HIV co-infected individuals.
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Affiliation(s)
- Edina Amponsah-Dacosta
- Vaccines for Africa Initiative, School of Public Health and Family Medicine, University of Cape Town, Cape Town 7925, Western Cape, South Africa
| | - Cynthia Tamandjou Tchuem
- Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town 7925, Western Cape, South Africa
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Vargas-Pacherrez D, Cotrim HP, Pires L, Cunha V, Coelho V, Brites C, Daltro C. Metabolic Syndrome in HIV-patients in Antiretroviral Therapy. Curr HIV Res 2020; 18:388-395. [PMID: 32516101 DOI: 10.2174/1570162x18666200609115615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/29/2020] [Accepted: 05/20/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The global prevalence of metabolic syndrome (MS) among people living with HIV/AIDS varies from 20% to 33%. OBJECTIVE to estimate the prevalence of metabolic syndrome and associated factors in a group of HIV-infected patients on antiretroviral therapy. METHODS This is a cross-sectional study with HIV-infected patients from a reference center in Bahia, Brazil. We evaluated clinical, socio-demographic and anthropometric data. MS was defined according to the guidelines of International Diabetes Federation. RESULTS We evaluated 152 patients with mean age of 47.3±11.6 years, 59.2% male. The main comorbidities detected were diabetes (3.3%) hypertriglyceridemia (9.3%) and metabolic syndrome (MS,38.2%). Patients with MS were predominantly women (55.2% vs 31.9%; p=0.005), older [52.1 (10.4) vs 44.3 (11.3); p<0.001], and had overweight (74.1% vs 23.4%; p<0.001). After multivariate analysis MS remained associated with age (OR = 1.076; 95% CI: 1.030 - 1.125), female sex (OR = 2.452; 95% CI: 1.114 - 5.374) and family history of hypertension (OR = 3.678; 95% CI: 1.431 - 9.395). CONCLUSION Almost half of the HIV-infected patients in Bahia presents with MS which seems to be driven by classical risk factors.
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Affiliation(s)
- Daniel Vargas-Pacherrez
- LAPI, Laboratório de Pesquisa em Infectologia. Complexo Hospitalar Professor Edgard Santos, Faculdade de Medicina da Bahia - Universidade Federal da Bahia (UFBA), Bahia, Brazil,Communicable Diseases and Environmental - Pan American Health Organization, Altamira - Caracas 1060, Venezuela
| | - Helma P Cotrim
- LAPI, Laboratório de Pesquisa em Infectologia. Complexo Hospitalar Professor Edgard Santos, Faculdade de Medicina da Bahia - Universidade Federal da Bahia (UFBA), Bahia, Brazil
| | - Leonardo Pires
- LAPI, Laboratório de Pesquisa em Infectologia. Complexo Hospitalar Professor Edgard Santos, Faculdade de Medicina da Bahia - Universidade Federal da Bahia (UFBA), Bahia, Brazil
| | - Vitor Cunha
- LAPI, Laboratório de Pesquisa em Infectologia. Complexo Hospitalar Professor Edgard Santos, Faculdade de Medicina da Bahia - Universidade Federal da Bahia (UFBA), Bahia, Brazil
| | - Vitor Coelho
- LAPI, Laboratório de Pesquisa em Infectologia. Complexo Hospitalar Professor Edgard Santos, Faculdade de Medicina da Bahia - Universidade Federal da Bahia (UFBA), Bahia, Brazil
| | - Carlos Brites
- LAPI, Laboratório de Pesquisa em Infectologia. Complexo Hospitalar Professor Edgard Santos, Faculdade de Medicina da Bahia - Universidade Federal da Bahia (UFBA), Bahia, Brazil,CoBraH Study Group - Universidade Federal da Bahia (UFBA), Bahia, Brazil
| | - Carla Daltro
- LAPI, Laboratório de Pesquisa em Infectologia. Complexo Hospitalar Professor Edgard Santos, Faculdade de Medicina da Bahia - Universidade Federal da Bahia (UFBA), Bahia, Brazil,Escola de Nutrição - Universidade Federal da Bahia (UFBA), Bahia, Brazil
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Bune GT, Yalew AW, Kumie A. Predictors of Metabolic Syndrome Among People Living with HIV in Gedeo-Zone, Southern-Ethiopia: A Case-Control Study. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2020; 12:535-549. [PMID: 33116916 PMCID: PMC7547778 DOI: 10.2147/hiv.s275283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/10/2020] [Indexed: 12/29/2022]
Abstract
Background Intensive access to antiretroviral therapy improved the prognosis of HIV. As a result, a non-communicable disease risk marker known as metabolic syndrome (MS) has emerged. It is a public health issue in sub-Saharan Africa including Ethiopia. However, there is little literature on predictors of MS among people living with HIV (PLHIVs) in the study area context. Purpose To identify predictors of metabolic syndrome among PLHIVs, Gedeo Zone, Southern-Ethiopia. Methods Health institutions-based unmatched case–control study was conducted. All HIV-infected adult persons who are receiving routine care in the randomly selected two hospitals and two health centers of the Gedeo zone, southern Ethiopia were involved in the study, conducted from December 29th, 2017, to January 22nd, 2019. PLHIVs diagnosed with MS using ATP III criteria were considered as a case, and subjects free of MS in the survey were enrolled as controls. Binary logistic regression was employed to identify predictors of MS. Results A total of 633 (139 cases and 494 controls) PLHIVs were included in the study. The multivariable analysis result found that age (AOR=1.09, 95% CI (1.05–1.12)); educational status being completed secondary school (AOR=0.22, 95% CI (0.02–0.42)); occupational status being of students (AOR=0.11, 95% CI (0.24–0.51)); wealth index being in the middle quintile (AOR=0.22, 95% CI (0.06–0.79)); ART status exposed to ART (AOR=3.07, 95% CI (1.37–6.89)); total physical activity state being physically active (AOR=0.36, 95% CI (0.16–0.79)), and engaged in low levels physical activity (AOR=3.83, 95% CI (1.46–10.05)) were the factors significantly associated with MS. Conclusion While education, occupation, wealth index, antiretroviral therapy status, total physical activity, and lower physical activity levels were concluded by the study as modifiable predictors of metabolic syndrome, age was found as a non-modifiable independent risk of metabolic syndrome. There is a need for an ongoing effort to realize an integrated care plan that addresses both the routine care and regular screening programs to reduce the risks associated with MS and its traits in these subjects.
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Affiliation(s)
| | | | - Abera Kumie
- Schools of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
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Gebrie A. The burden of metabolic syndrome in patients living with HIV/AIDS receiving care at referral hospitals of Northwest Ethiopia: A hospital-based cross-sectional study, 2019. Diabetes Metab Syndr 2020; 14:1551-1556. [PMID: 32947754 DOI: 10.1016/j.dsx.2020.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/31/2020] [Accepted: 08/02/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION There is a growing concern about metabolic syndrome among HIV-infected patients. Therefore, this study aims to determine the burden of metabolic syndrome among patients living with HIV/AIDS at referral hospitals of Northwest Ethiopia. MATERIALS AND METHODS a hospital-based cross-sectional study was conducted at referral hospitals of Northwest Ethiopia between February 2019 and April 2019. Using the WHO stepwise approach, sociodemographic, behavioral, and clinical data were collected from 407 adult patients. Lipid profiles, fasting blood sugar, as well as anthropometric indicators, were also measured. In addition, multivariate binary logistic regression analysis was performed. RESULTS The prevalence of metabolic syndrome was found to be 24.6% (95 CI: 20.42,28.78). Multivariate logistic regression analysis revealed that age [AOR (95% CI) 1.04 (1.003,1.074), p < 0.05]; female gender [AOR (95% CI) 9.66 (4.40, 21.22), p < 0.05]; marital status, single referent, separated [AOR (95% CI) 4.77 (1.83, 12.41), p < 0.05] and widowed [AOR (95% CI) 3.868(1.375, 10.883), p < 0.05]; monthly income (<2000 Ethiopian Birr referent) > 5000 ETB [AOR (95% CI) 3.543 (1.299, 9.664), p < 0.05]; and urban residence [AOR (95% CI) 2.118 (1.089, 4.119), p < 0.05] have shown statistically significant association with odds of metabolic syndrome. CONCLUSION The burden of metabolic syndrome was notably higher. Age, gender, marital status, monthly income, residence, waist circumference, and hypertension of patients were significantly associated with metabolic syndrome.
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Affiliation(s)
- Alemu Gebrie
- Department of Biomedical Science, School of Medicine, Debre Markos University, Debre Markos, Ethiopia.
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Møller SP, Amare H, Christensen DL, Yilma D, Abdissa A, Friis H, Faurholt-Jepsen D, Olsen MF. HIV and metabolic syndrome in an Ethiopian population. Ann Hum Biol 2020; 47:457-464. [PMID: 32683894 DOI: 10.1080/03014460.2020.1781929] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The global prevalence of metabolic syndrome (MS) is increasing due to lifestyle changes. Studies have found that MS is associated with human immunodeficiency virus (HIV) and antiretroviral treatment (ART), but controversies still exist on associations between HIV and MS. AIMS To assess associations between HIV and MS among ART-naïve HIV positive individuals compared to HIV negative individuals. SUBJECTS AND METHODS A cross-sectional study among ART-naïve HIV positive and HIV negative individuals recruited from HIV treatment and testing facilities in Ethiopia. Information was collected on components of MS: waist circumference, triglycerides, high-density lipoprotein cholesterol (HDL-C), blood pressure and fasting plasma glucose (FPG). Data were analysed using logistic and linear regression stratified by sex and adjusted for age, wealth and education. RESULTS Data from 329 HIV positive and 100 HIV negative individuals were included. HIV positive status was associated with higher odds of MS in women (OR: 3.56, 95%CI: 1.25; 10.15) (n = 292), but not in men (OR: 0.98, 95%CI: 0.22; 4.30) (n = 137), interaction: p= .11. Associations between HIV and components of MS were strongest for HDL-C among women and for FPG among men. The most prevalent components of MS in HIV positive individuals were elevated triglycerides, reduced HDL-C and elevated FPG. CONCLUSIONS HIV was associated with MS among ART-naïve women, suggesting that MS should be evaluated before initiating ART and monitored during treatment to identify those at risk of developing diabetes and cardiovascular disease (CVD).
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Affiliation(s)
- Sanne Pagh Møller
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark
| | - Hiwot Amare
- Department of Internal Medicine, Jimma University, Jimma, Ethiopia
| | - Dirk Lund Christensen
- Department of Public Health, Section of Global Health, Copenhagen University, Copenhagen, Denmark
| | - Daniel Yilma
- Department of Internal Medicine, Jimma University, Jimma, Ethiopia
| | - Alemseged Abdissa
- Department of Laboratory Sciences and Pathology, Jimma University, Jimma, Ethiopia
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark
| | - Daniel Faurholt-Jepsen
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Mette Frahm Olsen
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark
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Bune GT, Yalew AW, Kumie A. The extents of metabolic syndrome among Antiretroviral Therapy exposed and ART naïve adult HIV patients in the Gedeo-zone, Southern-Ethiopia: a comparative cross-sectional study. ACTA ACUST UNITED AC 2020; 78:40. [PMID: 32399212 PMCID: PMC7203886 DOI: 10.1186/s13690-020-00420-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 04/14/2020] [Indexed: 12/14/2022]
Abstract
Background HIV infection and Antiretroviral Therapy (ART) has been associated with metabolic syndrome (MS). The prevalence of MS varies substantially between populations and is not yet well-known in sub-Saharan Africa (SSA), including Ethiopia. The current study aims to estimate and evaluate the magnitude of MS among ART exposed and ART naïve HIV-infected patients. Methods A comparative cross-sectional design was employed among the randomly chosen PLHIVs from two hospitals and two health centers, found in the Gedeo zone, southern-Ethiopia. Data collection was run beginning from December 29th, 2017 up to January 22nd − 2019, using the WHO steep tool; eventually, the completed data entered into Epidata (V-3.1) and exported to SPSS (V− 22) for analysis. The revised international diabetes federation criterion was used to define MS and its components. The mean, standard deviations and proportions were used as a descriptive summary. Categorical data and the proportion of MS in the two groups were compared using binary logistic regression, and results were reported statistically significant with p-value is less than 5%. Results A total of 633 (n = 422 on ART and n = 211 ART-naive) PLHIVS was involved, with an overall response rate of 96.2%. The cumulative proportion of MS was 42.5%(95% CI: 39.2–45.7), with 43.4%(95% CI: 39.1–47.4) among ART exposed and 40.8% (95% CI: 35.5–46.0) among ART naïve patients (P > 0.005). However, the difference was not statistically significant and signified that ART has no association with an increased proportion of MS. Conclusion Overall this study demonstrated the presence of an elevated degree of overall MS among PLHIVs. Besides, although the difference was not statistically significant, a relatively higher proportion of MS was realized in the ART exposed than ART naïve groups. Implicated that at the time of the entire test and treatment approaches employed in this target group, routine screening of MS incorporated through HIV care and management system will be a vibrant action.
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Affiliation(s)
| | | | - Abera Kumie
- 2Schools of Public Health, Addis Ababa University/AAU, Addis Ababa, Ethiopia
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Yitbarek GY, Engidaw MT, Ayele BA, Tiruneh SA, Alamir MT. Magnitude of Obesity/Overweight and Its Associated Factors Among HIV/AIDS Patients on Antiretroviral Therapy in Jimma Zone Hospitals, South West Ethiopia: Hospital-Based Cross-Sectional Study. Diabetes Metab Syndr Obes 2020; 13:1251-1258. [PMID: 32368118 PMCID: PMC7183745 DOI: 10.2147/dmso.s247221] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 04/04/2020] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Obesity is on the rise worldwide, not only in the general population but also in PLWHA. Being overweight and obese are themselves risk factors for cardiovascular and other diseases. Despite this, few studies have been conducted to determine the magnitude of obesity/overweight and its associated factors among HIV/AIDS patients in Ethiopia, which necessitates this study. METHODS Hospital-based cross-sectional study was conducted from December to January 2019 at selected Jimma zone hospitals. WHO STEP-wise approach to chronic disease risk factor surveillance (STEPS) questionnaire and document review for HIV-related clinical factors was applied. Weight, height and waist circumference and hip circumference were measured. Data were analyzed using SPSS version 20. RESULTS A total of 252 participants with a response rate of 95.8% were included. The prevalence of obesity/overweight was 21%. After adjusting for these variables, age category of greater than 50 years [AOR = 0.4, 95% CI (0.2, 0.9), p = 0.03], WHO clinical stage III and above [AOR = 0.04, 95% CI (0.002, 0.6), p = 0.02], presence of mild to moderate physical activity [AOR = 1.3, 95% CI (5.5, 33.3), p ≤ 0.001)], plasma CD4 count between 351 and 500 copies/mL [AOR=0.15, 95% CI (0.04, 0.6) p=0.024], and female sex [AOR = 2.6, 95% CI (1.25, 10) p=0.03)] were significantly associated with obesity/overweight. CONCLUSION There was a high prevalence of obesity/overweight among HIV/AIDS patients. It was found that older age, female sex, early stage of the disease, lower CD4 count and presence of mild to moderate physical activity were significant predictors of obesity/overweight. Clinicians should be aware of the health consequence of obesity and consider instituting targeted weight management programs as a part of routine HIV care.
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Affiliation(s)
- Getachew Yideg Yitbarek
- Department of Biomedical Sciences (Medical Physiology), College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Melaku Tadege Engidaw
- Department of Social and Public Health (Human Nutrition), College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | | | - Sofonyas Abebaw Tiruneh
- Department of Social and Public Health (Epidemiology), College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Melkamu Tilahun Alamir
- Department of Biomedical Sciences (Medical Physiology), College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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Bune GT, Yalew AW, Kumie A. The global magnitude of metabolic syndrome among antiretroviral therapy (ART) exposed and ART-naïve adult HIV-infected patients in gedio-zone, southern Ethiopia: Comparative cross-sectional study, using the Adult Treatment Panel III criteria. Diabetes Metab Syndr 2019; 13:2833-2841. [PMID: 31425944 DOI: 10.1016/j.dsx.2019.07.051] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 07/29/2019] [Indexed: 02/07/2023]
Abstract
AIM The global operation of antiretroviral therapy (ART) has averted 30 million new infections and nearly 8 million deaths; however, it has an impact on metabolic syndrome (MS) acquisition. As a result, there is growing concern about MS; but strangely the magnitude of MS in HIV-infected cohort, and its differential contribution ART status in Ethiopia has yet to be abundantly studied. Hence, the aim of this study was to estimate and evaluate the difference of the overall magnitude of MS among ART exposed and ART naïve people living with HIV (PLWH). MATERIALS AND METHODS An institution based cross-sectional study was conducted at the randomly chosen two hospitals and health centers, in Gedio zone, southern Ethiopia between December 29th, 2017 and January 22nd, 2019. Data were collected using the WHO three step tools. The collected data were fed into Epidata version.3.1 and exported to SPSS version 22 for analysis. The descriptive complex sample analysis method was employed, and the prevalence and differences between groups were computed with a 95% CI. RESULT A total of 633 (n = 422 ART and n = 211 ART naive) PLWH was involved, with the response rate of 92.1%. Of whom, 22.0% (95% CI: 19.0-25.4) of PLWH had MS. It was slightly higher in the ART-exposed (22.5%, 95% CI: 18.7-26.8) than ART naïve (20.9%, 95% CI: 15.2-27.1) group. CONCLUSION The global magnitude of MS in the ART-exposed was relatively higher than ART naïve groups. This dictates the existence of HIV associated MS that necessitates immediate prevention and management strategies.
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Affiliation(s)
| | | | - Abera Kumie
- Schools of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
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Coronel-Castillo CE, Qi X, Contreras-Carmona J, Ramírez-Pérez OL, Méndez-Sánchez N. Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis in HIV infection: a metabolic approach of an infectious disease. Expert Rev Gastroenterol Hepatol 2019; 13:531-540. [PMID: 30905208 DOI: 10.1080/17474124.2019.1599284] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
With the successes of antiretroviral therapy, patients infected with human immunodeficiency virus (HIV) living longer. Regarding this, the common diseases of HIV population (i.e., opportunistic infections) are now losing ground in front of metabolic alterations. This phenomenon is related to the delay in progression to acquired immune deficiency syndrome (AIDS), making it so that patients live in a chronic inflammatory state which, combined with other mechanisms such infectious ones, cause metabolic diseases. Areas covered: Considering a high prevalence of metabolic alterations, the relationship between metabolic syndrome (MetS) with nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH), and liver diseases as a major cause of death in the HIV-infected population, this paper aims to overview the mechanisms and prevalence of NAFLD and NASH as they relate to the developed metabolic diseases of HIV patients. Expert opinion: The pathways underlying MetS include the effects of HIV and ART on the liver, adipose tissue, and muscle. These mechanisms result in liver damage, consequently leading to NAFLD and its more severe form NASH. These conditions have increased in HIV-infected population in recent years and since their life expectancy is improving it is important to be ready to attend their new emerging diseases.
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Affiliation(s)
| | - Xingshun Qi
- b Department of Gastroenterology , General Hospital of Shenyang Military Area , Shenyang , China
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Todowede OO, Mianda SZ, Sartorius B. Prevalence of metabolic syndrome among HIV-positive and HIV-negative populations in sub-Saharan Africa-a systematic review and meta-analysis. Syst Rev 2019; 8:4. [PMID: 30606249 PMCID: PMC6317235 DOI: 10.1186/s13643-018-0927-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 12/19/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Metabolic syndrome (MetS) is a constellation of conditions that increase the risk of cardiovascular diseases. It is an emerging concern in sub-Saharan African (SSA) countries, particularly because of an increasingly aging population and lifestyle changes. There is an increased risk of MetS and its components among people living with Human immune deficiency syndrome (HIV) individuals; however, the prevalence of metabolic syndrome in the SSA population and its differential contribution by HIV status is not yet established. This systematic review and meta-analysis were conducted to estimate the pooled prevalence of metabolic syndrome in people living with HIV and uninfected populations, its variation by sub-components. METHODS We performed a comprehensive search on major databases-MEDLINE (PubMed), EBSCOhost, and Cochrane Database of Systematic Reviews and Web of sciences for original epidemiological research articles that compared proportions of the MetS and its subcomponents between people living with HIV and uninfected patients and published between January 1990-December 2017. The inclusion criteria were adults aged ≥ 18 years, with confirmed HIV status. We assessed the risk of bias using a prevalence studies tool, and random effect meta-analyses were used to compute the pooled overall prevalence. RESULTS A total of four cross-sectional studies comprising 496 HIV uninfected and 731 infected participants were included in the meta-analysis. The overall prevalence of MetS among people living with HIV was 21.5% (95% CI 15.09-26.86) versus uninfected 12.0% (95% CI 5.00-21.00%), with substantial heterogeneity. The reported relative risk estimate for MetS among the two groups was twofold (RR 1.83, 95% CI 0.98-3.41), with an estimated predictive interval of 0.15 to 22.43 and P = 0.055 higher for the infected population. Hypertension was the most prevalent MetS sub-components, with diverse proportions of people living with HIV (5.2-50.0%) and uninfected (10.0-59.0%) populations. CONCLUSIONS The high range of MetS prevalence in the HIV-infected population compared to the uninfected population highlights the possible presence of HIV related drivers of MetS. Also, the reported high rate of MetS, irrespective of HIV status, indicates a major metabolic disorder epidemic that requires urgent prevention and management programs in SSA. Similarly, in the era of universal test and treat strategy among people living with HIV cohorts, routine check-up of MetS sub-components is required in HIV management as biomarkers. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016045727.
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Affiliation(s)
- Olamide O Todowede
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4001, South Africa.
| | - Solange Z Mianda
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4001, South Africa
| | - Benn Sartorius
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4001, South Africa.,Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, USA
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Hidalgo JA, Florez A, Agurto C, Pinedo Y, Ayarza R, Rodriguez L, La Rosa A, Gutierrez R. Metabolic and Cardiovascular Comorbidities Among Clinically Stable HIV Patients on Long-Term ARV Therapy in Five Ambulatory Clinics in Lima-Callao, Peru. Open AIDS J 2018; 12:126-135. [PMID: 30450147 PMCID: PMC6198417 DOI: 10.2174/1874613601812010126] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 08/17/2018] [Accepted: 08/18/2018] [Indexed: 12/17/2022] Open
Abstract
Background: There is scarcity of data about the prevalence of non-AIDS defining comorbidities among stable HIV-infected patients in Peru. Objective: We aimed to describe the most frequent cardiometabolic comorbidities found among ambulatory adults on ARV in Peru. Methods: A review of records for patients attending regular visits at 5 clinics in Lima-Callao in January-February 2016 is presented. Patients were adults on ARV for >6 months, with no recent AIDS-defining condition. Results: Three hundred and five medical charts were reviewed. Most patients were male (73.1%, n=223) with a mean age of 46.0 years. Mean time from HIV diagnosis was 9.41 yrs. and mean duration of ARV was 7.78 yrs. Most patients were on an NNRTI-based first line regimen (76.4%, n=233), and 12.1% (n=37) were on rescue regimens. Median CD4 count was 614.2 cells/µL and the proportion of patients with viral load <40 c/mL was 90.8% (n=277). Most frequent metabolic diagnoses were dyslipidemia (51.5%, n=157), obesity (11.1%, n=34), and diabetes mellitus (7.2%, n=22). Hypertension was diagnosed in 8.9% (n=27). Other diagnoses of cardiovascular disease were documented in 3.3% (n=10). Pharmacologic treatment was prescribed in 91.3% of patients with diabetes or hypertension, but in only 29.3% of patients with dyslipidemia. Conclusion: A high proportion of metabolic comorbidities was found, with dyslipidemia being the most frequent, followed by obesity and diabetes. In contrast, cardiovascular disease was documented less frequently. Medical treatment was started for only a third of dyslipidemia patients. HIV care policies need to consider proper management of chronic comorbidities to optimize long-term outcomes.
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Affiliation(s)
- Jose A Hidalgo
- Almenara Hospital, Lima, Peru.,Vía Libre HIV Clinic, Lima, Lima
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Phalane E, Fourie CMT, Schutte AE. The metabolic syndrome and renal function in an African cohort infected with human immunodeficiency virus. South Afr J HIV Med 2018; 19:813. [PMID: 30349743 PMCID: PMC6191676 DOI: 10.4102/sajhivmed.v19i1.813] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 03/29/2018] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION The human immunodeficiency virus (HIV) is often accompanied by renal dysfunction. It is expected that metabolic syndrome (MetS) may exacerbate renal impairment. OBJECTIVE We therefore determined the prevalence of MetS and the association thereof with renal function in a South African cohort infected with HIV. METHODS We matched 114 HIV-infected (77.3% on antiretroviral therapy [ART] and 22.7% ART-naïve) and 114 HIV-uninfected individuals according to age, sex and locality. We examined cardiovascular, anthropometric and metabolic measurements and determined the MetS. Renal function was assessed using standardised procedures. RESULTS The prevalence of MetS was lower in the HIV-infected individuals as compared to the uninfected individuals (28% vs. 44%, p = 0.013). The HIV-infected group presented with a lower body mass index (BMI) and waist circumference (WC) (all p < 0.001), as well as blood pressure (BP) (p ≤ 0.0021). The results were confirmed when comparing the HIV-infected group using ART (N = 85) and the HIV-uninfected group. When comparing the HIV-infected individuals with MetS to the HIV-uninfected individuals with MetS, no differences in BP were seen. With regard to renal function, the HIV-infected individuals with MetS (n = 32) had 43% higher urinary albumin-creatinine ratio (uACR) compared to the HIV-uninfected individuals with MetS, after adjusting for age, sex and WC (p = 0.032). None of the other renal function markers differed after adjustments for WC or BMI. CONCLUSION The HIV-infected Africans with MetS had almost twofold higher uACR, despite the low prevalence of MetS, compared to their uninfected counterparts. The combination of HIV and MetS seemed to increase the risk for renal impairment.
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Affiliation(s)
- Edith Phalane
- Hypertension in Africa Research Team, North-West University, South Africa
| | - Carla M T Fourie
- Hypertension in Africa Research Team, North-West University, South Africa
- Medical Research Council Unit for Hypertension and Cardiovascular Disease, Faculty of Health Sciences, North-West University, South Africa
| | - Aletta E Schutte
- Hypertension in Africa Research Team, North-West University, South Africa
- Medical Research Council Unit for Hypertension and Cardiovascular Disease, Faculty of Health Sciences, North-West University, South Africa
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Luna MI. Alterations of Glucose Metabolism in HIV-Infected Patients. CURRENT TROPICAL MEDICINE REPORTS 2018. [DOI: 10.1007/s40475-018-0154-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Dimala CA, Blencowe H, Choukem SP. The association between antiretroviral therapy and selected cardiovascular disease risk factors in sub-Saharan Africa: A systematic review and meta-analysis. PLoS One 2018; 13:e0201404. [PMID: 30059546 PMCID: PMC6066235 DOI: 10.1371/journal.pone.0201404] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 06/13/2018] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND With increasing adverse cardiovascular disease (CVD) outcomes in HIV/AIDS patients, the possible contribution of antiretroviral therapy (ART) to the prevailing CVD epidemic in sub-Saharan Africa (SSA) through its effect on CVD risk factors has rather been under investigated. This study aimed to assess the extent to which ART is associated with hypertension, diabetes mellitus (DM) and dyslipidemia in SSA. METHODS This is a systematic review and meta-analysis of studies from SSA, published between January 1946 and December 2017, from Medline, Embase, Africa-wide Information, the Cochrane library, African Index and Medicus databases. Both observational and interventional studies with comparable ART-treated and ART-naïve populations were selected and data was extracted from eligible studies. Pooled estimates of the effect of ART on the outcomes of interest (hypertension, diabetes and abnormal lipid profiles) were obtained using random effects meta-analysis, and meta-regression analysis was used to explore between-study heterogeneity. RESULTS Twenty cross-sectional studies were included involving 5386 participants. There was no association between ART use and hypertension (OR: 1.9, 95%CI: 0.96-3.76, n = 8, I2 = 73.8%) and DM (OR: 2.53, 95%CI: 0.87-7.35, n = 8, I2 = 73.8%). ART use was associated with high total cholesterol (OR: 3.85, 95%CI: 2.45-6.07, n = 8, I2 = 67.0%), high triglycerides (OR: 1.46, 95%CI: 1.21-1.75, n = 14, I2 = 10.0%) and high LDL-cholesterol (OR: 2.38, 95%CI: 1.43-3.95, n = 11, I2 = 87.6%). ART was associated with rather lower odds of having low HDL-cholesterol (OR: 0.53, 95%CI: 0.32-0.87, n = 8, I2 = 78.2%). There was evidence of between-study heterogeneity for all outcomes except high triglycerides. CONCLUSIONS ART appears to be associated with CVD risk in HIV/AIDS patients in SSA only through dyslipidemia but not through hypertension and DM, however, high quality and robust research in SSA is mandated to accurately ascertain the actual contribution of ART to the CVD burden in this part of the world. Nevertheless, HIV/AIDS patients should still benefit from systematic CVD screening alongside their regular care services. TRIAL REGISTRATION Prospero Registration - CRD42016042306.
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Affiliation(s)
- Christian Akem Dimala
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Orthopaedics, Southend University Hospital, Essex, United Kingdom
- Health and Human Development (2HD) Research Network, Douala, Cameroon
| | - Hannah Blencowe
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Simeon Pierre Choukem
- Health and Human Development (2HD) Research Network, Douala, Cameroon
- Diabetes and Endocrinology Unit, Department of Internal Medicine, Douala General Hospital, Douala, Cameroon
- Department of Internal Medicine and Paediatrics, Faculty of health Sciences, University of Buea, Buea, Cameroon
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Noncommunicable diseases among HIV-infected persons in low-income and middle-income countries: a systematic review and meta-analysis. AIDS 2018; 32 Suppl 1:S5-S20. [PMID: 29952786 DOI: 10.1097/qad.0000000000001888] [Citation(s) in RCA: 151] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To appropriately identify and treat noncommunicable diseases (NCDs) among persons living with HIV (PLHIV) in low-and-middle-income countries (LMICs), it is imperative to understand the burden of NCDs among PLHIV in LMICs and the current management of the diseases. DESIGN Systematic review and meta-analysis. METHODS We examined peer-reviewed literature published between 1 January 2010 and 31 December 2016 to assess currently available evidence regarding HIV and four selected NCDs (cardiovascular disease, cervical cancer, depression, and diabetes) in LMICs with a focus on sub-Saharan Africa. The databases, PubMed/MEDLINE, Cochrane Review, and Scopus, were searched to identify relevant literature. For conditions with adequate data available, pooled estimates for prevalence were generated using random fixed effects models. RESULTS Six thousand one hundred and forty-three abstracts were reviewed, 377 had potentially relevant prevalence data and 141 were included in the summary; 57 were selected for quantitative analysis. Pooled estimates for NCD prevalence were hypertension 21.2% (95% CI 16.3-27.1), hypercholesterolemia 22.2% (95% CI 14.7-32.1), elevated low-density lipoprotein 23.2% (95% CI 15.2-33.6), hypertriglyceridemia 27.2% (95% CI 20.7-34.8), low high-density lipoprotein 52.3% (95% CI 35.6-62.8), obesity 7.8% (95% CI 4.3-13.9), and depression 24.4% (95% CI 12.5-42.1). Invasive cervical cancer and diabetes prevalence were 1.3-1.7 and 1.3-18%, respectively. Few NCD-HIV integrated programs with screening and management approaches that are contextually appropriate for resource-limited settings exist. CONCLUSION Improved data collection and surveillance of NCDs among PLHIV in LMICs are necessary to inform integrated HIV/NCD care models. Although efforts to integrate care exist, further research is needed to optimize the efficacy of these programs.
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Huis In 't Veld D, Pengpid S, Colebunders R, Peltzer K. Body Mass Index and Waist Circumference in Patients with HIV in South Africa and Associated Socio-demographic, Health Related and Psychosocial Factors. AIDS Behav 2018; 22:1972-1986. [PMID: 28243935 DOI: 10.1007/s10461-017-1737-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A high body mass index (BMI) and high waist circumference are important health risk factors predisposing for cardiovascular and metabolic diseases and certain cancers. Historically, underweight was a diagnostic criterion of HIV-infection. In a cross-sectional study the prevalence of BMI-categories and high waist circumference and its associated factors in patients visiting three outpatient HIV clinics in South Africa were measured with anthropometric measurements and structured questionnaires regarding socio-demographic information, quality of life (QoL), AIDS-related stigma, symptoms of depression, alcohol use, HIV related information and level of adherence to ART. The median age of the 2230 included patients was 37 years, 66.5% were women and 88.6% received antiretroviral therapy. The prevalences of overweight, obesity and high waist circumference were 29.2, 21.9 and 44.6% respectively in women and 12.4, 4.0 and 3.9% respectively in men. Underweight was found in 18.2% of men and 6.3% of women. In multinomial regression analysis compared to a normal BMI, both overweight and obesity were associated with female gender, with being married or cohabiting and with a higher QoL score. Underweight was associated with male gender and tobacco use and negatively associated with being married or cohabiting and the physical domain of the QoL measure. A high waist circumference in men was associated with higher age and negatively associated with tobacco use and stigma score. In women it was negatively associated with never being married. A high prevalence of overweight and obesity was observed in HIV-clinics in South Africa, mainly in women. Since overweight and obesity are important health risk factors, effective weight reduction interventions are desirable.
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Affiliation(s)
- Diana Huis In 't Veld
- Department of Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium.
- FWO Research Foundation Flanders, Brussels, Belgium.
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
- Algemeen inwendige geneeskunde, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Supa Pengpid
- ASEAN Institute for Health Development, Mahidol University, Nakhonpathom, Thailand
- Department of Research and Innovation, University of Limpopo, Sovenga, South Africa
| | - Robert Colebunders
- Department of Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Karl Peltzer
- ASEAN Institute for Health Development, Mahidol University, Nakhonpathom, Thailand
- HIV/AIDS, STIs & TB (HAST) Research Programme, Human Sciences Research Council, Pretoria, South Africa
- Department of Psychology, University of Limpopo, Sovenga, South Africa
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Ekoru K, Young EH, Dillon DG, Gurdasani D, Stehouwer N, Faurholt-Jepsen D, Levitt NS, Crowther NJ, Nyirenda M, Njelekela MA, Ramaiya K, Nyan O, Adewole OO, Anastos K, Compostella C, Dave JA, Fourie CM, Friis H, Kruger IM, Longenecker CT, Maher DP, Mutimura E, Ndhlovu CE, Praygod G, Pefura Yone EW, Pujades-Rodriguez M, Range N, Sani MU, Sanusi M, Schutte AE, Sliwa K, Tien PC, Vorster EH, Walsh C, Gareta D, Mashili F, Sobngwi E, Adebamowo C, Kamali A, Seeley J, Smeeth L, Pillay D, Motala AA, Kaleebu P, Sandhu MS. HIV treatment is associated with a two-fold higher probability of raised triglycerides: Pooled Analyses in 21 023 individuals in sub-Saharan Africa. Glob Health Epidemiol Genom 2018; 3:e7. [PMID: 29881632 PMCID: PMC5985947 DOI: 10.1017/gheg.2018.7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 04/08/2018] [Accepted: 04/10/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Anti-retroviral therapy (ART) regimes for HIV are associated with raised levels of circulating triglycerides (TG) in western populations. However, there are limited data on the impact of ART on cardiometabolic risk in sub-Saharan African (SSA) populations. METHODS Pooled analyses of 14 studies comprising 21 023 individuals, on whom relevant cardiometabolic risk factors (including TG), HIV and ART status were assessed between 2003 and 2014, in SSA. The association between ART and raised TG (>2.3 mmol/L) was analysed using regression models. FINDINGS Among 10 615 individuals, ART was associated with a two-fold higher probability of raised TG (RR 2.05, 95% CI 1.51-2.77, I2=45.2%). The associations between ART and raised blood pressure, glucose, HbA1c, and other lipids were inconsistent across studies. INTERPRETATION Evidence from this study confirms the association of ART with raised TG in SSA populations. Given the possible causal effect of raised TG on cardiovascular disease (CVD), the evidence highlights the need for prospective studies to clarify the impact of long term ART on CVD outcomes in SSA.
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Affiliation(s)
- K. Ekoru
- Department of Medicine, University of Cambridge, Cambridge, UK
- Global Health and Populations Group, Wellcome Trust Sanger Institute, Hinxton, Cambridge, UK
| | - E. H. Young
- Department of Medicine, University of Cambridge, Cambridge, UK
- Global Health and Populations Group, Wellcome Trust Sanger Institute, Hinxton, Cambridge, UK
| | - D. G. Dillon
- Weill Cornell Medical College, New York City, New York, USA
| | - D. Gurdasani
- Department of Medicine, University of Cambridge, Cambridge, UK
- Global Health and Populations Group, Wellcome Trust Sanger Institute, Hinxton, Cambridge, UK
| | - N. Stehouwer
- University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - D. Faurholt-Jepsen
- Department of Infectious Diseases, University of Copenhagen (Rigshospitalet), Copenhagen, Denmark
| | - N. S. Levitt
- Division of Diabetic Medicine and Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - N. J. Crowther
- Department of Chemical Pathology, National Health Laboratory Service, University of the Witwatersrand Medical School, Johannesburg, South Africa
| | - M. Nyirenda
- Malawi Epidemiology and Intervention Research Unit, Malawi, Lilongwe
| | - M. A. Njelekela
- Department of Physiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - K. Ramaiya
- Shree Hindu Mandal Hospital, Dar es Salaam, Tanzania
| | - O. Nyan
- Royal Victoria Teaching Hospital, School of Medicine, University of The Gambia, Banjul, The Gambia
| | - O. O. Adewole
- Department of Medicine, Obafemi Awolowo University, Ile Ife, Nigeria
| | - K. Anastos
- Albert Einstein College of Medicine, Bronx NY, USA
| | - C. Compostella
- Department of Medicine, University of Padua, Padua, Italy
| | - J. A. Dave
- Division of Diabetic Medicine and Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - C. M. Fourie
- HART (Hypertension in Africa Research Team), North-West University, Potchefstroom, South Africa
| | - H. Friis
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Denmark
| | - I. M. Kruger
- Africa Unit for Transdisciplinary Health Research (AUTHeR), North-West University, Potchefstroom, South Africa
| | | | - D. P. Maher
- Special Programme for Research & Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
| | - E. Mutimura
- Albert Einstein College of Medicine, Bronx NY, USA
| | - C. E. Ndhlovu
- Clinical Epidemiology Resource Training Centre, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - G. Praygod
- National Institute for Medical Research, Tanzania, Dar es Salaam
| | | | - M. Pujades-Rodriguez
- Epicentre, Médecins Sans Frontières, Paris, France
- Department of Epidemiology and Public Health, University College of London, Clinical Epidemiology Group, London, UK
| | - N. Range
- National Institute for Medical Research, Tanzania, Dar es Salaam
| | - M. U. Sani
- Cardiology Unit, Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - M. Sanusi
- Cardiology Unit, Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - A. E. Schutte
- HART (Hypertension in Africa Research Team), North-West University, Potchefstroom, South Africa
- MRC Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - K. Sliwa
- Soweto Cardiovascular Research Unit, Chris Hani Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - P. C. Tien
- Department of Medicine, University of California, San Francisco, USA
| | - E. H. Vorster
- Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - C. Walsh
- Department of Nutrition and Dietetics, University of the Free State, Bloemfontein, South Africa
| | - D. Gareta
- Africa Health Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | - F. Mashili
- National Institute for Medical Research, Tanzania, Dar es Salaam
| | - E. Sobngwi
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Cameroon, Yaoundé
| | - C. Adebamowo
- Institute of Human Virology, Abuja, Nigeria
- Department of Epidemiology and Public Health, Institute of Human Virology and Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, USA
| | - A. Kamali
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
| | - J. Seeley
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
| | - L. Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - D. Pillay
- Africa Health Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | - A. A. Motala
- Department of Diabetes and Endocrinology, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - P. Kaleebu
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
| | - M. S. Sandhu
- Department of Medicine, University of Cambridge, Cambridge, UK
- Global Health and Populations Group, Wellcome Trust Sanger Institute, Hinxton, Cambridge, UK
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Njuguna B, Kiplagat J, Bloomfield GS, Pastakia SD, Vedanthan R, Koethe JR. Prevalence, Risk Factors, and Pathophysiology of Dysglycemia among People Living with HIV in Sub-Saharan Africa. J Diabetes Res 2018; 2018:6916497. [PMID: 30009182 PMCID: PMC5989168 DOI: 10.1155/2018/6916497] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 04/03/2018] [Accepted: 04/15/2018] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To review available literature on the prevalence, risk factors, pathophysiology, and clinical outcomes of dysglycemia among people living with HIV (PLHIV) in sub-Saharan Africa (SSA). METHODS Database search on PUBMED for eligible studies describing the prevalence, risk factors, pathophysiology, or clinical outcomes of dysglycemia in SSA PLHIV. RESULTS Prevalence of diabetes mellitus (DM) and pre-DM among SSA PLHIV ranged from 1% to 26% and 19% to 47%, respectively, in 15 identified studies. Older age and an elevated body mass index (BMI) were common risk factors for dysglycemia. Risk factors potentially more specific to PLHIV in SSA included exposure to older-generation thymidine analogues or protease inhibitors, malnutrition at ART initiation, a failure to gain fat mass on treatment, and elevated serum lipids. There is evidence of higher nephropathy and neuropathy rates among PLHIV in SSA with comorbid DM compared to HIV-negative individuals with DM. CONCLUSION There is a need for longitudinal studies to enhance understanding of the risk factors for dysglycemia among PLHIV in SSA, further research into optimal therapies to reduce pre-DM progression to DM among SSA PLHIV, and studies of the burden and phenotype of diabetic complications and other health outcomes among PLHIV with comorbid DM in SSA.
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Affiliation(s)
- Benson Njuguna
- Moi Teaching and Referral Hospital, P.O. Box 4606-30100, Eldoret, Kenya
| | - Jepchirchir Kiplagat
- Academic Model Providing Access to Healthcare (AMPATH), P.O. Box 4606-30100, Eldoret, Kenya
| | - Gerald S. Bloomfield
- Duke Clinical Research Institute, Duke Global Health Institute, Duke University, 2400 Pratt Street, Durham, NC 27710, USA
| | - Sonak D. Pastakia
- Purdue University College of Pharmacy, P.O. Box 5760 Eldoret 30100, Kenya
| | - Rajesh Vedanthan
- Zena and Michael A. Wiener Cardiovascular Institute, Department of Medicine and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, P.O. Box 1030, New York, NY 10029, USA
| | - John R. Koethe
- Division of Infectious Diseases, Vanderbilt University Medical Center, A2200-MCN 1161 21st Avenue South, Nashville, TN 37232, USA
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Bosho DD, Dube L, Mega TA, Adare DA, Tesfaye MG, Eshetie TC. Prevalence and predictors of metabolic syndrome among people living with human immunodeficiency virus (PLWHIV). Diabetol Metab Syndr 2018; 10:10. [PMID: 29483948 PMCID: PMC5822556 DOI: 10.1186/s13098-018-0312-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 02/12/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Use of combination antiretroviral therapy (cART) has led to significant reductions in morbidity and mortality. However, there is a growing concern about metabolic syndromes (MS), among patients receiving cART. Despite this fact, there is limited evidence for the prevalence of the MS among HIV-infected persons receiving cART in developing countries, particularly Ethiopia. OBJECTIVE To determine the prevalence and predictors of MS among people living with HIV/AIDS in Jimma health centre, Jimma Zone south west Ethiopia. METHODS A cross-sectional study was conducted on people living with HIV/AIDS (PLWHA) in Jimma health centre that fulfilled the inclusion criteria. Data on demographic and anthropometric characteristics were collected using World health organization (WHO) stepwise approach. Fasting blood glucose and lipid profile was measured. The Third Report of National Cholesterol Education Program-adult treatment panel III (NCEP-ATP III)-2001, the International Diabetes Federation (IDF)-2005 and the Joint interim statement-2009 (JIS) criteria were used to define MS. Data were analyzed using statistical software package (SPSS) version 20.0. Logistic regression analysis was done to identify predictors of MS and predictors with p value < 0.05 were used to declare statistical significance. RESULTS Of 268 HIV-infected participants included in the analysis, 211 (78.7%) were women. The mean age of the participants was 39.32 ± 10.626 years. Using the NCEP-ATP III criteria, the prevalence of MS was found to be 23.5% (63 patients). While it was 20.5% (55 patients) and 27.6% (74 patients) with IDF and JIS criteria respectively. Enrollment in formal education resulted in 75% increment in the odds of MS (AOR = 0.25, 95% CI [0.072-0.879]). The odds of MS in patients with body mass index > 25 kg/m2 was elevated to 13.4 times (AOR = 13.39, 95% CI [3.943-45.525]) and exposure to D-drugs was attributed to 59% increment in the odds of MS (AOR = 1.59, 95% CI [0.58-4.56]), although the finding lacks statistical significance. CONCLUSIONS Metabolic syndromes was relatively common to the study population. Hence, promoting health education and monitoring patient's clinical and laboratory parameters at every visit and taking appropriate measure is ideal.
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Affiliation(s)
- Dula Dessalegn Bosho
- Department of Pharmacy, Faculty of Health Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Lemessa Dube
- Department of Epidemiology, Public Health Faculty, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Teshale Ayele Mega
- Department of Pharmacy, Faculty of Health Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Dawit Abera Adare
- Department of Medical Laboratory, Jimma University Medical Centre, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Mikyas Gashaw Tesfaye
- Department of Medical Laboratory, Jimma University Medical Centre, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Tesfahun Chanie Eshetie
- Department of Pharmacy, Faculty of Health Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
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Husain NE, Noor SK, Elmadhoun WM, Almobarak AO, Awadalla H, Woodward CL, Mital D, Ahmed MH. Diabetes, metabolic syndrome and dyslipidemia in people living with HIV in Africa: re-emerging challenges not to be forgotten. HIV AIDS (Auckl) 2017; 9:193-202. [PMID: 29184449 PMCID: PMC5685138 DOI: 10.2147/hiv.s137974] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The current challenge in managing people living with human immunodeficiency virus (PLWHIV) includes the identification and monitoring for comorbid health risks associated with HIV and its treatment and longer survival. Dyslipidemia, diabetes mellitus and metabolic syndrome are increasingly seen in PLWHIV. OBJECTIVE In this narrative review, we aimed to summarize the current knowledge about diabetes, dyslipidemia and metabolic syndrome in PLWHIV in Africa and also to discuss the challenges that patients as well as health authorities in Africa may face. METHODS PubMed and Google scholar published-English literatures concerning earlier mentioned entities regardless of time limit were critically reviewed. RESULTS The prevalence of metabolic disorders in HIV population in Africa was estimated to range from 2.1% to 26.5% for diabetes and 20.2% to 43.5% for pre-diabetes, 13% to 58% for metabolic syndrome and 13% to 70% for dyslipidemia. CONCLUSION The management of metabolic disorders and cardiovascular disease risks related to HIV is complex especially in Africa due to healthcare resources, but our experience suggests that metabolic clinic is beneficial to patients and staff and should be an important part of HIV services especially as the older HIV population is increasing. In this context, cardiovascular risk assessment of HIV-infected patients will become an important component of care in developing countries in Africa and strategies are needed to deal with progressive increase in the epidemic of type 2 diabetes, dyslipidemia and metabolic syndrome.
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Affiliation(s)
- Nazik Elmalaika Husain
- Department of Pathology, Faculty of Medicine and Health Sciences, Omdurman Islamic University, Khartoum
| | | | - Wadie M Elmadhoun
- Department of Pathology, Faculty of Medicine and Health Sciences, Nile Valley University, Atbara
| | - Ahmed O Almobarak
- Department of Pathology, Faculty of Medicine, University of Medical Sciences and Technology
| | - Heitham Awadalla
- Department of Community Medicine, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Clare L Woodward
- Department of HIV and Genitourinary Medicine, Milton Keynes University Hospital, NHS Foundation Trust, Milton Keynes, UK
| | - Dushyant Mital
- Department of HIV and Genitourinary Medicine, Milton Keynes University Hospital, NHS Foundation Trust, Milton Keynes, UK
| | - Mohamed H Ahmed
- Department of Medicine and HIV Metabolic Clinic, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes, UK
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Nduka CU, Stranges S, Kimani PK, Sarki AM, Uthman OA. Is there sufficient evidence for a causal association between antiretroviral therapy and diabetes in HIV-infected patients? A meta-analysis. Diabetes Metab Res Rev 2017; 33. [PMID: 28437854 DOI: 10.1002/dmrr.2902] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 02/03/2017] [Accepted: 03/28/2017] [Indexed: 01/22/2023]
Abstract
The association of antiretroviral therapy (ART) with diabetes is inconsistent and varies widely across primary epidemiological studies. A comprehensive and more precise estimate of this association is fundamental to establishing a plausible causal link between ART and diabetes. We identified epidemiological studies that compared mean fasting plasma glucose (FPG) concentrations and proportions of diabetes and metabolic syndrome between HIV-infected patients naïve and exposed to ART. Mean difference in FPG concentrations and odds ratios of diabetes and metabolic syndrome were pooled using random-effects meta-analyses. Data on 20 178 participants from 41 observational studies were included in the meta-analyses. Mean FPG concentrations (Pooled mean difference: 4.66 mg/dL; 95% confidence interval [CI], 2.52 to 6.80; 24 studies) and the odds of diabetes (Pooled odds ratios: 3.85; 95% CI, 2.93 to 5.07; 10 studies) and metabolic syndrome (Pooled odds ratios: 1.45; 95% CI, 1.03 to 2.03; 18 studies) were significantly higher among ART-exposed patients, compared to their naïve counterparts. ART was also associated with significant increases in FPG levels in studies with mean ART duration ≥18 months (Pooled mean difference: 4.97 mg/dL; 95% CI, 3.10 to 6.84; 14 studies), but not in studies with mean ART duration <18 months (Pooled mean difference: 4.40 mg/dL, 95% CI, -0.59 to 9.38; 7 studies). ART may potentially be the single most consistent determinant of diabetes in people living with HIV worldwide. However, given the preponderance of cross-sectional studies in the meta-analysis, the association between ART and diabetes cannot be interpreted as cause and effect.
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Affiliation(s)
- Chidozie U Nduka
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Saverio Stranges
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, Ontario, Canada
- Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Peter K Kimani
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Ahmed M Sarki
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Olalekan A Uthman
- Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Warwick Medical School, University of Warwick, Coventry, UK
- Department of Public Health (IHCAR), Karolinska Institutet, Stockholm, Sweden
- Centre for Evidence-Based Health Care, Stellenbosch University, Tygerberg, South Africa
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Metabolic clinic for individuals with HIV/AIDS: a commitment and vision to the future of HIV services. Cardiovasc Endocrinol 2017; 6:109-112. [PMID: 31646127 DOI: 10.1097/xce.0000000000000128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 05/30/2017] [Indexed: 12/17/2022] Open
Abstract
One of the biggest current challenges in managing an ageing cohort living with the HIV is handling dyslipidaemia, diabetes, metabolic syndrome and nonalcoholic fatty liver disease. Combination antiretroviral therapy decrease mortality and morbidity in HIV patients, but lead to increase in insulin resistance, dyslipidaemia, abnormalities of fat distribution and high risk of cardiovascular disease. Therefore, a metabolic clinic was established for individuals living with HIV in the Milton Keynes University Hospital NHS Foundation Trust. The clinic meets considerable demands by service users and hence has the potential to be popular. This review focuses on the importance of the development of a metabolic clinic for the purpose of audit, research, teaching and exchange of knowledge between HIV specialists and the metabolic team in the management of complex cases. Therefore, the metabolic clinic should be an integral part of HIV services especially as the cohort of the 'older' HIV population increases.
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Kolgiri V, Nagar V, Patil V. Association of Metabolic Syndrome and Oxidative DNA Damage in HIV/AIDS Patients. Indian J Clin Biochem 2017; 33:273-281. [PMID: 30072826 DOI: 10.1007/s12291-017-0670-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 06/07/2017] [Indexed: 11/27/2022]
Abstract
HIV-infected adults may be likely to have metabolic syndrome (MS) at younger ages and in the absence of obesity compared with general population. In the present study, we determined prevalence of MS and its association with oxidative deoxy nucleic acid (DNA) damage in HIV-1 infected patients with different ART status. We used plasma level of the oxidized base, 8-hydroxy-2-deoxyguanosine (8-OHdG), as a biomarker of oxidative DNA damage. To measure plasma 8-OHdG we used 8-OHdG enzyme-linked, immunosorbent assay. The biomarkers of MS were insulin resistance, Cholesterol/HDL ratio, Waist circumference and Hypertension. MS and oxidative DNA damage were significantly higher in HIV-positive patients with second line ART and first line ART than ART-naive patients. In a logistic regression analysis, increased MS was positively associated with the increased DNA damage (OR: 29.68, 95%:13.47, CI: 65.40) P = 0.0001. ART plays a significant role in the development of MS and oxidative DNA damage in HIV-positive patients taking antiretroviral therapy. Awareness and knowledge of MS and DNA damage in HIV/AIDS patients may prove helpful to clinicians to manage non-AIDS diseases such as cardiovascular disease and cancer. To determine exact role of ART in induction of MS and DNA damage larger studies are warranted.
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Affiliation(s)
- Vaishali Kolgiri
- Department of Biochemistry and Medicine, Grant Government Medical College and Sir J J Groups of Hospitals, Mumbai, 400008 India
| | - Vidya Nagar
- Department of Biochemistry and Medicine, Grant Government Medical College and Sir J J Groups of Hospitals, Mumbai, 400008 India
| | - Vinayak Patil
- Department of Biochemistry and Medicine, Grant Government Medical College and Sir J J Groups of Hospitals, Mumbai, 400008 India
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Labhardt ND, Müller UF, Ringera I, Ehmer J, Motlatsi MM, Pfeiffer K, Hobbins MA, Muhairwe JA, Muser J, Hatz C. Metabolic syndrome in patients on first-line antiretroviral therapy containing zidovudine or tenofovir in rural Lesotho, Southern Africa. Trop Med Int Health 2017; 22:725-733. [PMID: 28342180 DOI: 10.1111/tmi.12872] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To assess the prevalence of metabolic syndrome (MetS) among patients in rural Lesotho who are taking first-line antiretroviral therapy (ART) containing either zidovudine or tenofovir disoproxil. METHODS Cross-sectional survey in 10 facilities in Lesotho among adult (≥16 years) patients on non-nucleoside reverse transcriptase inhibitor (NNRTI)-based first-line ART for ≥6 months. MetS was defined according to the International Diabetes Federation criteria. RESULTS Among 1166 patients (65.8% female), 22.2% (95% CI: 19.3-25.3) of women and 6.3% (4.1-9.1) of men met the IDF definition of MetS (P < 0.001). In both sexes, there was no significant difference in MetS prevalence between NNRTIs. However, in women taking zidovudine as nucleoside reverse transcriptase inhibitor (NRTI), MetS prevalence was 27.9%, vs. 18.8% in those taking tenofovir. In the multivariate logistic regression allowing for socio-demographic and clinical covariates, ART containing zidovudine was associated with MetS in women (aOR 2.17 (1.46-3.22), P < 0.001) but not in men. CONCLUSION In this study, taking ART containing zidovudine instead of tenofovir disoproxil was an independent predictor of MetS in women but not in men. This finding endorses WHO's recommendation of tenofovir as preferred NRTI.
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Affiliation(s)
- Niklaus Daniel Labhardt
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Urs Franz Müller
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Isaac Ringera
- SolidarMed, Swiss Organization for Health in Africa, Maseru West, South Africa
| | - Jochen Ehmer
- SolidarMed, Swiss Organization for Health in Africa, Luzern, Switzerland
| | - Mokete M Motlatsi
- SolidarMed, Swiss Organization for Health in Africa, Maseru West, South Africa
| | - Karolin Pfeiffer
- SolidarMed, Swiss Organization for Health in Africa, Luzern, Switzerland
| | - Michael A Hobbins
- SolidarMed, Swiss Organization for Health in Africa, Luzern, Switzerland
| | | | - Juergen Muser
- Central Laboratories, Cantonal Hospital Basel-Land, Liestal, Switzerland
| | - Christoph Hatz
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
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Prioreschi A, Munthali RJ, Soepnel L, Goldstein JA, Micklesfield LK, Aronoff DM, Norris SA. Incidence and prevalence of type 2 diabetes mellitus with HIV infection in Africa: a systematic review and meta-analysis. BMJ Open 2017; 7:e013953. [PMID: 28360243 PMCID: PMC5372101 DOI: 10.1136/bmjopen-2016-013953] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES This systematic review aims to investigate the incidence and prevalence of type 2 diabetes mellitus (T2DM) in patients with HIV infection in African populations. SETTING Only studies reporting data from Africa were included. PARTICIPANTS A systematic search was conducted using four databases for articles referring to HIV infection and antiretroviral therapy, and T2DM in Africa. Articles were excluded if they reported data on children, animals or type 1 diabetes exclusively. MAIN OUTCOME MEASURES Incidence of T2DM and prevalence of T2DM. Risk ratios were generated for pooled data using random effects models. Bias was assessed using an adapted Cochrane Collaboration bias assessment tool. RESULTS Of 1056 references that were screened, only 20 were selected for inclusion. Seven reported the incidence of T2DM in patients with HIV infection, eight reported the prevalence of T2DM in HIV-infected versus uninfected individuals and five reported prevalence of T2DM in HIV-treated versus untreated patients. Incidence rates ranged from 4 to 59 per 1000 person years. Meta-analysis showed no significant differences between T2DM prevalence in HIV-infected individuals versus uninfected individuals (risk ratio (RR) =1.61, 95% CI 0.62 to 4.21, p=0.33), or between HIV-treated patients versus untreated patients (RR=1.38, 95% CI 0.66 to 2.87, p=0.39), and heterogeneity was high in both meta-analyses (I2=87% and 52%, respectively). CONCLUSIONS Meta-analysis showed no association between T2DM prevalence and HIV infection or antiretroviral therapy; however, these results are limited by the high heterogeneity of the included studies and moderate-to-high risk of bias, as well as, the small number of studies included. There is a need for well-designed prospective longitudinal studies with larger population sizes to better assess incidence and prevalence of T2DM in African patients with HIV. Furthermore, screening for T2DM using gold standard methods in this population is necessary. TRIAL REGISTRATION NUMBER PROSPERO42016038689.
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Affiliation(s)
- A Prioreschi
- MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - R J Munthali
- MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - L Soepnel
- MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J A Goldstein
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - L K Micklesfield
- MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - D M Aronoff
- Division of Infectious Disease, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - S A Norris
- MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Honnapurmath VK, Patil VW. Antiretroviral Therapy-induced Insulin Resistance and Oxidative Deoxy Nucleic Acid Damage in Human Immunodeficiency Virus-1 Patients. Indian J Endocrinol Metab 2017; 21:316-321. [PMID: 28459032 PMCID: PMC5367237 DOI: 10.4103/2230-8210.202029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Insulin resistance (IR) is frequent in human immunodeficiency virus (HIV) infection and may be related to antiretroviral therapy (ART). Increased oxidative stress parameters and carbonyl protein are linked to insulin sensitivity. The present study is aimed to determine IR, its association with oxidative deoxy nucleic acid (DNA) damage in HIV-1-infected patients with different ART status. MATERIALS AND METHODS In this case-control study, a total 600 subjects were included. We used plasma levels of the oxidized base, 8-hydroxy-2-deoxyguanosine (8-OHdG), as our biomarker of oxidative DNA damage. 8-OHdG was measured with the highly sensitive 8-OHdG check enzyme-linked immunosorbent assay kit. IR was determined using homeostasis model assessment. RESULTS All subjects were randomly selected and grouped as HIV-negative (control group) (n = 300), HIV-positive without ART (n = 100), HIV-positive with ART first line (n = 100), and HIV-positive with ART second line (n = 100). IR and oxidative DNA damage were significantly higher in HIV-positive patients with second-line ART and HIV-positive patients with first-line ART than ART-naive patients. In a linear regression analysis, increased IR was positively associated with the increased DNA damage (odds ratio: 3.052, 95% confidence interval: 2.595-3.509) P < 0.001. INTERPRETATION AND CONCLUSIONS In this study, we observed that ART plays a significant role in the development of IR and oxidative DNA damage in HIV-positive patients taking ART. Awareness and knowledge of these biomarkers may prove helpful to clinicians while prescribing ART to HIV/AIDS patients. Larger studies are warranted to determine the exact role of ART in the induction of IR and DNA damage.
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Affiliation(s)
- Vaishali Kolgiri Honnapurmath
- Department of Biochemistry, Grant Government Medical College and Sir J J Groups of Hospitals, Mumbai, Maharashtra, India
| | - V. W. Patil
- Department of Biochemistry, Grant Government Medical College and Sir J J Groups of Hospitals, Mumbai, Maharashtra, India
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Naidu S, Ponnampalvanar S, Kamaruzzaman SB, Kamarulzaman A. Prevalence of Metabolic Syndrome Among People Living with HIV in Developing Countries: A Systematic Review. AIDS Patient Care STDS 2017; 31:1-13. [PMID: 28051897 DOI: 10.1089/apc.2016.0140] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Metabolic syndrome (MS) is a group of components associated with cardiovascular disease and type 2 diabetes mellitus. The prevalence of MS in the HIV population is increasing in epidemic proportions globally. However, the magnitude and characteristics of MS are not fully elucidated in developing countries. The aim of this systematic review was to assess the prevalence of MS and its components among people living with HIV (PLWH) in developing countries. Searches were carried out in MEDLINE, Embase, Web of Science, CINAHL, Cochrane Central Register of Controlled Trials, Scopus, other web sources, and by hand search. Articles were restricted to English language studies reporting on the prevalence of MS among PLWH in developing countries. Eighteen articles were included in the review. The studies were divided into Africa, South America, and Asia regions. The most frequent criterion used in the review was the National Cholesterol Education Program: Adult Treatment Program III 2001 definition. The prevalence of MS among PLWH ranged from 8.4% to 47% across the developing regions and comparable to the overall prevalence across the developed regions (7.8-52.2%). The mean prevalence was 30.5%, 21.5%, and 21.4% in Africa, Asia, and South America, respectively. The most frequent component observed was low high-density lipoprotein cholesterol (50.1%). This systematic review provides an essential overview on the distribution of MS in the HIV population across the developing regions. As these prevalences were comparably high in the developed regions, this review highlights the need for more robust research in developing countries.
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Affiliation(s)
- Sivaraj Naidu
- Center of Excellence for Research in AIDS, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sasheela Ponnampalvanar
- Center of Excellence for Research in AIDS, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Division of Infectious Disease, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Shahrul Bahyah Kamaruzzaman
- Division of Geriatric, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Adeeba Kamarulzaman
- Center of Excellence for Research in AIDS, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Division of Infectious Disease, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Steiniche D, Jespersen S, Erikstrup C, Krarup H, Handberg A, Østergaard L, Haraldsdottir T, Medina C, Gomes Correira F, Laursen AL, Bjerregaard-Andersen M, Wejse C, Hønge BL. Diabetes mellitus and impaired fasting glucose in ART-naïve patients with HIV-1, HIV-2 and HIV-1/2 dual infection in Guinea-Bissau: a cross-sectional study. Trans R Soc Trop Med Hyg 2016; 110:219-27. [PMID: 27076509 PMCID: PMC4830405 DOI: 10.1093/trstmh/trw017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 02/12/2016] [Accepted: 03/01/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The prevalence of diabetes mellitus (DM) is expected to increase in sub-Saharan Africa. Patients with HIV are at particular risk. We investigated the DM burden among antiretroviral therapy (ART)-naïve patients with HIV in Guinea-Bissau. METHODS Patients were consecutively included. Demographic and lifestyle data were collected and one fasting blood glucose (FBG) measurement was used to diagnose DM (FBG≥7.0 mmol/L) and impaired fasting glucose (IFG) (FBG≥6.1 and <7.0 mmol/L). RESULTS By June 2015, 953 newly diagnosed ART-naïve patients with HIV had been included in the study of whom 893 (93.7%) were fasting at the time of inclusion. Median age among the fasting patients was 37 years (IQR 30-46 years) and 562 (62.9%) were women. The prevalence of DM was 5.8% (52/893) while 5.6% (50/893) had IFG. DM was associated with family history of DM (OR 3.92, 95% CI 1.78 to 8.63), being 41-50 years (OR 2.98, 95% CI 1.18 to 7.49) or older than 50 years (OR 3.14, 95% CI 1.09 to 9.07) and Fula ethnicity (OR 2.72, 95% CI 1.12 to 6.62). CONCLUSIONS DM prevalence was higher among younger patients compared with the background population in Bissau. Traditional risk factors for DM such as advancing age and a family history of DM apply also for ART-naïve patients with HIV.
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Affiliation(s)
- Ditte Steiniche
- Bandim Health Project, Indepth Network, 1004 Bissau, Guinea-Bissau Department of Infectious Diseases, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Sanne Jespersen
- Bandim Health Project, Indepth Network, 1004 Bissau, Guinea-Bissau Department of Infectious Diseases, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Christian Erikstrup
- Department of Clinical Immunology, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Henrik Krarup
- Section of Molecular Diagnostics, Clinical Biochemistry, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - Aase Handberg
- Department of Clinical Biochemistry, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - Lars Østergaard
- Department of Infectious Diseases, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | | | - Candida Medina
- National HIV Programme, Ministry of Health, 1004 Bissau, Guinea-Bissau
| | | | - Alex Lund Laursen
- Department of Infectious Diseases, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Morten Bjerregaard-Andersen
- Bandim Health Project, Indepth Network, 1004 Bissau, Guinea-Bissau Department of Endocrinology, Odense University Hospital, 5000 Odense, Denmark Research Center for Vitamins and Vaccines, Statens Serum Institute, Copenhagen, Denmark
| | - Christian Wejse
- Bandim Health Project, Indepth Network, 1004 Bissau, Guinea-Bissau Department of Infectious Diseases, Aarhus University Hospital, 8200 Aarhus N, Denmark GloHAU, Center for Global Health, School of Public Health, Aarhus University, 8000 Aarhus Denmark
| | - Bo Langhoff Hønge
- Bandim Health Project, Indepth Network, 1004 Bissau, Guinea-Bissau Department of Clinical Immunology, Aarhus University Hospital, 8200 Aarhus N, Denmark
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Nguyen KA, Peer N, Mills EJ, Kengne AP. A Meta-Analysis of the Metabolic Syndrome Prevalence in the Global HIV-Infected Population. PLoS One 2016; 11:e0150970. [PMID: 27008536 PMCID: PMC4805252 DOI: 10.1371/journal.pone.0150970] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 02/22/2016] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Cardio-metabolic risk factors are of increasing concern in HIV-infected individuals, particularly with the advent of antiretroviral therapy (ART) and the subsequent rise in longevity. However, the prevalence of cardio-metabolic abnormalities in this population and the differential contribution, if any, of HIV specific factors to their distribution, are poorly understood. Therefore, we conducted a systematic review and meta-analysis to estimate the global prevalence of metabolic syndrome (MS) in HIV-infected populations, its variation by the different diagnostic criteria, severity of HIV infection, ART used and other major predictive characteristics. METHODS We performed a comprehensive search on major databases for original research articles published between 1998 and 2015. The pooled overall prevalence as well as by specific groups and subgroups were computed using random effects models. RESULTS A total of 65 studies across five continents comprising 55094 HIV-infected participants aged 17-73 years (median age 41 years) were included in the final meta-analysis. The overall prevalence of MS according to the following criteria were: ATPIII-2001:16.7% (95%CI: 14.6-18.8), IDF-2005: 18% (95%CI: 14.0-22.4), ATPIII-2004-2005: 24.6% (95%CI: 20.6-28.8), Modified ATPIII-2005: 27.9% (95%CI: 6.7-56.5), JIS-2009: 29.6% (95%CI: 22.9-36.8), and EGIR: 31.3% (95%CI: 26.8-36.0). By some MS criteria, the prevalence was significantly higher in women than in men (IDF-2005: 23.2% vs. 13.4, p = 0.030), in ART compared to non-ART users (ATPIII-2001: 18.4% vs. 11.8%, p = 0.001), and varied significantly by participant age, duration of HIV diagnosis, severity of infection, non-nucleoside reverse transcriptase inhibitors (NNRTIs) use and date of study publication. Across criteria, there were significant differences in MS prevalence by sub-groups such as in men, the Americas, older publications, regional studies, younger adults, smokers, ART-naïve participants, NNRTIs users, participants with shorter duration of diagnosed infection and across the spectrum of HIV severity. Substantial heterogeneities across and within criteria were not fully explained by major study characteristics, while evidence of publication bias was marginal. CONCLUSIONS The similar range of MS prevalence in the HIV-infected and general populations highlights the common drivers of this condition. Thus, cardio-metabolic assessments need to be routinely included in the holistic management of the HIV-infected individual. Management strategies recommended for MS in the general population will likely provide similar benefits in the HIV-infected.
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Affiliation(s)
- Kim A Nguyen
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Nasheeta Peer
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Andre P Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Medicine, University of Cape Town, Cape Town, South Africa
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Adébayo A, Albert DC, Ericie S, Angelo AC, Jules G, Armand W, Séraphin A, Léopold C, Gabriel A. [Prevalence, associated and predisposing factors of metabolic syndrome among people living with HIV on antiretroviral treatment in Porto Novo in 2014]. Pan Afr Med J 2015; 22:296. [PMID: 26966492 PMCID: PMC4769044 DOI: 10.11604/pamj.2015.22.296.7923] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 11/15/2015] [Indexed: 12/15/2022] Open
Affiliation(s)
- Alassani Adébayo
- Centre Hospitalier Universitaire Départemental du Borgou-Alibori, Parakou, Bénin
| | | | - Sossou Ericie
- Faculté des Sciences de la Santé, UAC Cotonou, Bénin
| | | | - Gninkoun Jules
- Centre National Hospitalier Universitaire Hubert Koutoucou Maga, Cotonou, Bénin
| | - Wanvoegbe Armand
- Centre Hospitalier Universitaire Départemental de l'Ouémé-Plateau, Porto-Novo, Bénin
| | - Ahoui Séraphin
- Centre Hospitalier Universitaire Départemental du Borgou-Alibori, Parakou, Bénin
| | - Codjo Léopold
- Centre Hospitalier Universitaire Départemental du Borgou-Alibori, Parakou, Bénin
| | - Ade Gabriel
- Centre National Hospitalier Universitaire Hubert Koutoucou Maga, Cotonou, Bénin
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Belachew T. Are we ready for the rising silent epidemic of metabolic syndrome and chronic non-communicable disease in Ethiopia? Ethiop J Health Sci 2015; 25:1-2. [PMID: 25733778 PMCID: PMC4337081 DOI: 10.4314/ejhs.v25i1.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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