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Steffen HM, Mahanani MR, Neuhann F, Nhlema A, Kasper P, de Forest A, Chaweza T, Tweya H, Heller T, Chiwoko J, Winkler V, Phiri S. Blood pressure changes during tenofovir-based antiretroviral therapy among people living with HIV in Lilongwe, Malawi: results from the prospective LighTen Cohort Study. Clin Res Cardiol 2023; 112:1650-1663. [PMID: 37414923 PMCID: PMC10584708 DOI: 10.1007/s00392-023-02253-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/20/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Sub-Saharan Africa is one of the regions in the world with the highest numbers of uncontrolled hypertension as well as people living with HIV/AIDS (PLHIV). However, the association between hypertension and antiretroviral therapy is controversial. METHODS Participant demographics, medical history, laboratory values, WHO clinical stage, current medication, and anthropometric data were recorded at study entry and during study visits at 1, 3, 6 months, and every 6 months thereafter until month 36. Patients who stopped or changed their antiretroviral therapy (tenofovir, lamivudine, efavirenz) were censored on that day. Office blood pressure (BP) was categorized using ≥ 2 measurements on ≥ 2 occasions during the first three visits. Factors associated with systolic and mean BP were analyzed using bivariable and multivariable multilevel linear regression. RESULTS 1,288 PLHIV (751 females, 58.3%) could be included and 832 completed the 36 months of observation. Weight gain and a higher BP level at study entry were associated with an increase in BP (p < 0.001), while female sex (p < 0.001), lower body weight at study entry (p < 0.001), and high glomerular filtration rate (p = 0.009) protected against a rise in BP. The rate of uncontrolled BP remained high (73.9% vs. 72.1%) and despite indication treatment, adjustments were realized in a minority of cases (13%). CONCLUSION Adherence to antihypertensive treatment and weight control should be addressed in patient education programs at centers caring for PLHIV in low-resources settings like Malawi. Together with intensified training of medical staff to overcome provider inertia, improved control rates of hypertension might eventually be achieved. TRIAL REGISTRATION NCT02381275.
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Affiliation(s)
- Hans-Michael Steffen
- Department of Gastroenterology and Hepatology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
- Hypertension Center, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
| | | | - Florian Neuhann
- Institute for Global Health, University of Heidelberg, Heidelberg, Germany
- School of Medicine and Clinical Sciences, Levy Mwanawasa Medical University, Lusaka, Zambia
| | | | - Philipp Kasper
- Department of Gastroenterology and Hepatology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Andrew de Forest
- Institute for Global Health, University of Heidelberg, Heidelberg, Germany
| | | | - Hannock Tweya
- International Training and Education Center for Health, University of Washington, Seattle, WA, USA
| | - Tom Heller
- Lighthouse Clinic, Lilongwe, Malawi
- International Training and Education Center for Health, University of Washington, Seattle, WA, USA
| | | | - Volker Winkler
- Institute for Global Health, University of Heidelberg, Heidelberg, Germany
| | - Sam Phiri
- Lighthouse Clinic, Lilongwe, Malawi
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Department of Public Health and Family Medicine, Kamuzu University of Health Sciences, Lilongwe, Malawi
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24-h-Ambulatory Blood Pressure Monitoring in Sub-Saharan Africa: Hypertension Phenotypes and Dipping Patterns in Malawian HIV+ Patients on Antiretroviral Therapy. Glob Heart 2021; 16:67. [PMID: 34692392 PMCID: PMC8516010 DOI: 10.5334/gh.945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 09/22/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Cardiovascular disease and especially hypertension are a growing problem among people living with HIV (PLHIV) on antiretroviral therapy (ART) in sub-Saharan Africa. Objectives: As robust data on hypertension phenotypes associated with distinct cardiovascular risks among PLHIV are limited, we aimed to assess the frequency of white-coat (WCH), masked (MH) hypertension, and blood pressure dipping-patterns in a group of Malawian PLHIV. Methods: As part of the prospective Lighthouse-Tenofovir-Cohort-Study, we analyzed clinical, laboratory and 24-h-ambulatory blood pressure monitoring (ABPM) data of PLHIV from urban Lilongwe with treated or untreated hypertension or raised office blood pressure (OBP) during routine study-visits. Results: 118 PLHIV were included and data of 117 participants could be analyzed. Twenty–four-hour ABPM normotension was found in a total of 73 PLHIV including 14/37 on antihypertensive treatment (37.8%). Using strict definitions, i.e. normal OBP plus normal mean BP for all periods of ABPM, controlled hypertension was found in only 4/37 (10.8%) PLHIV on antihypertensive treatment while true normotension was observed in 10/24 untreated patients (41.7%) with previously diagnosed hypertension and 22/56 patients (39.3%) without a medical history of hypertension. WCH with normal BP during all periods of 24-h-ABPM was identified in 12/64 OBP-hypertensive PLHIV (18.8%), primarily in patients with grade 1 hypertension (11/41 patients; 26.8%). MH was found in 17/53 PLHIV with OBP-normotension (32.1%), predominantly in patients with high normal BP (11/20 patients; 55%). The estimated glomerular filtration rate tended to be lower in MH compared to strictly defined normotensive PLHIV (92.0±20.4 vs. 104.8±15.7 ml/min/m²). 64.1 percent of PLHIV (59.5% with 24-h hypertension and 66.7% with 24-h normotension) had abnormal systolic dipping. Conclusion: The high prevalence of WCH and MH with signs of early renal end-organ damage and an abnormal dipping in approximately 2/3 of PLHIV warrants further investigation as these factors may contribute to the increased cardiovascular risk in PLHIV in resource-limited settings like Malawi. Clinical Trial Registration: https://clinicaltrials.gov (NCT02381275), registered March 6th, 2015.
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Fraser A, Newberry Le Vay J, Byass P, Tollman S, Kahn K, D'Ambruoso L, Davies JI. Time-critical conditions: assessment of burden and access to care using verbal autopsy in Agincourt, South Africa. BMJ Glob Health 2020; 5:e002289. [PMID: 32377406 PMCID: PMC7199706 DOI: 10.1136/bmjgh-2020-002289] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 03/19/2020] [Accepted: 03/27/2020] [Indexed: 11/04/2022] Open
Abstract
Background Time-critical conditions (TCC) are estimated to cause substantial mortality in low and middle-income countries. However, quantification of deaths and identification of contributing factors to those deaths are challenging in settings with poor health records. Aim To use verbal autopsy (VA) data from the Agincourt health and sociodemographic surveillance system in rural South Africa to quantify the burden of deaths from TCC and to evaluate the barriers in seeking, reaching and receiving quality care for TCC leading to death. Methodology Deaths from 1993 to 2015 were analysed to identify causality from TCC. Deaths due to TCC were categorised as communicable, non-communicable, maternal, neonatal or injury-related. Proportion of deaths from TCC by age, sex, condition type and temporal trends was described. Deaths due to TCC from 2012 to 2015 were further examined by circumstances of mortality (CoM) indicators embedded in VA. Healthcare access, at illness onset and during the final day of life, as well as place of death, was extracted from free text summaries. Summaries were also analysed qualitatively using a Three Delays framework to identify barriers to healthcare. Results Of 15 305 deaths, 5885 (38.45%) were due to TCC. Non-communicable diseases were the most prevalent cause of death from TCC (2961/5885 cases, 50.31%). CoM indicators highlighted delays in a quarter of deaths due to TCC, most frequently in seeking care. The most common pattern of healthcare access was to die outwith a facility, having sought no healthcare (409/1324 cases, 30.89%). Issues in receipt of quality care were identified by qualitative analysis. Conclusion TCCs are responsible for a substantial burden of deaths in this rural South African population. Delays in seeking and receiving quality care were more prominent than those in reaching care, and thus further research and solution development should focus on healthcare-seeking behaviour and quality care provision.
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Affiliation(s)
- Andrew Fraser
- Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Peter Byass
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.,Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.,Aberdeen Centre for Health Data Science, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Dentistry, University of Aberdeen, Aberdeen, UK
| | - Stephen Tollman
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathleen Kahn
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Lucia D'Ambruoso
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.,Aberdeen Centre for Health Data Science, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Dentistry, University of Aberdeen, Aberdeen, UK
| | - Justine I Davies
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.,Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Hamill MM, Pettifor JM, Ward KA, Norris SA, Prentice A. Bone Mineral Density, Body Composition, and Mineral Homeostasis Over 24 Months in Urban South African Women With HIV Exposed to Antiretroviral Therapy. JBMR Plus 2020; 4:e10343. [PMID: 32382690 PMCID: PMC7202419 DOI: 10.1002/jbm4.10343] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 12/11/2019] [Accepted: 01/19/2020] [Indexed: 12/17/2022] Open
Abstract
Human immunodeficiency virus- (HIV-) infection and antiretroviral therapy (ART) exposure are associated with bone loss. African data are limited despite the region's HIV burden. Of 247 ART-naïve, premenopausal, urban, black African women aged 33.9 ± 6.6 years from Soweto, South Africa, measured at baseline, 110 underwent anthropometry, DXA, and blood and urine collections at 12 and 24 months; 39 were HIV-negative (Nref), 28 were people with HIV (PWH) not ART-exposed for the duration of the study (ART-N), and 43 were PWH who were ART-exposed within the first 12 months (ART-Y). At baseline, the ART-Y group had lower BMI and fat mass than the Nref group. Within 12 months of ART initiation, areal bone mineral density (aBMD) had decreased at the lumbar spine and at the whole body less head, despite increased weight, and hip aBMD had not increased in line with the Nref group. There was no evidence of further bone changes between 12 and 24 months. By 24 months, the ART-Y women had gained weight and fat mass, but remained lighter with less fat than the Nref women. ART initiation normalized the low serum albumin of the ART-Y group at baseline, but was associated with elevated bone turnover markers at 12 and 24 months. Vitamin D status and renal phosphate handling were normal. ART-N had similar aBMD and other characteristics to the Nref group throughout, except unlike the Nref group, weight and fat mass did not increase and serum albumin decreased. This study in African women of childbearing age demonstrated that the bone loss that had occurred in these PWH after ART initiation did not continue after 12 months and that bone loss did not occur in ART-unexposed PWH over 2 years. At 24 months, despite gains in weight and fat mass, ART-exposed women remained lighter, with lower aBMD, fat mass, and higher bone turnover than women without HIV. More studies are required to establish if the bone loss and fat gain reverse, stabilize, or continue with further ART exposure, particularly during and after menopause. © 2020 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Matthew M Hamill
- Medical Research Council Elsie Widdowson Laboratory Cambridge UK.,South African Medical Research Council/University of Witwatersrand Developmental Pathways for Health Research Unit, Faculty of Health Sciences University of Witwatersrand Johannesburg South Africa.,Division of Infectious Diseases, Bayview Medical Center Johns Hopkins University School of Medicine Baltimore MD USA
| | - John M Pettifor
- South African Medical Research Council/University of Witwatersrand Developmental Pathways for Health Research Unit, Faculty of Health Sciences University of Witwatersrand Johannesburg South Africa
| | - Kate A Ward
- Medical Research Council Elsie Widdowson Laboratory Cambridge UK
| | - Shane A Norris
- South African Medical Research Council/University of Witwatersrand Developmental Pathways for Health Research Unit, Faculty of Health Sciences University of Witwatersrand Johannesburg South Africa
| | - Ann Prentice
- Medical Research Council Elsie Widdowson Laboratory Cambridge UK.,South African Medical Research Council/University of Witwatersrand Developmental Pathways for Health Research Unit, Faculty of Health Sciences University of Witwatersrand Johannesburg South Africa
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5
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Onen BL, Harris C, Ignatowicz A, Davies J, Drouvelis M, Howes A, Nkomazana O, Onen CL, Sapey E, Tsima B, Lasserson D. Ageing, frailty and resilience in Botswana: rapid ageing, rapid change. Findings from a national working group meeting and literature review. BMC Proc 2019; 13:8. [PMID: 31827603 PMCID: PMC6862741 DOI: 10.1186/s12919-019-0171-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background The demography of Botswana is rapidly changing. Successes in tackling communicable diseases and economic development increased life expectancy from 53.7 years in 2006 to 66.8 years in 2016. The prevalence of diseases associated with older age, especially chronic non-communicable diseases including diabetes, hypertension and cerebrovascular disease are suspected to have increased but accurate data are lacking. The country has high youth unemployment and national retirement is at the age of 60, which limits the opportunity to build pensions for prosperity in older age. Changes across health, social care and economic policy are needed to prepare for a future ageing population. Methods This article reports on the national working group meeting outputs on issues that face older people, their families, healthcare providers, and policy makers in Botswana. A collaborative working group meeting was convened in Gaborone, Botswana on 25th September 2018 by the University of Botswana and University of Birmingham, UK, to identify key challenges and opportunities for an ageing Batswana population. Results There was agreement across diverse stakeholders of a need for effective and rapid policy formation to prepare and protect the future health and economy of an ageing Batswana population with a high burden of NCDs. The main priorities for policy-makers must be social care, poverty reduction and healthcare provision, conducted in an evidence-based manner, as far as practicable. To effectively achieve this, research and high-quality data collection mechanisms are required. Conclusions Future policy in Botswana must focus on the challenges that an ageing population brings, and development of health and care system resilience for the demographic change could be a model for healthcare policy across Southern Africa.
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Affiliation(s)
- Barbara Lachana Onen
- 1Royal Free London NHS Foundation Trust, London, UK.,2Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Ciara Harris
- 3Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Justine Davies
- 3Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Andrew Howes
- 5School of Computer Science, University of Birmingham, Birmingham, UK
| | | | | | - Elizabeth Sapey
- 7Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Billy Tsima
- 2Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Daniel Lasserson
- 3Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Manne‐Goehler J, Siedner MJ, Montana L, Harling G, Geldsetzer P, Rohr J, Gómez‐Olivé F, Goehler A, Wade A, Gaziano T, Kahn K, Davies JI, Tollman S, Bärnighausen TW. Hypertension and diabetes control along the HIV care cascade in rural South Africa. J Int AIDS Soc 2019; 22:e25213. [PMID: 30916897 PMCID: PMC6436499 DOI: 10.1002/jia2.25213] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 11/02/2018] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Participation in antiretroviral therapy (ART) programmes has been associated with greater utilization of care for hypertension and diabetes in rural South Africa. The objective of this study was to assess whether people living with HIV on ART with comorbid hypertension or diabetes also have improved chronic disease management indicators. METHODS The Health and Aging in Africa: a longitudinal study of an INDEPTH Community in South Africa (HAALSI) is a cohort of 5059 adults >40 years old. Enrollment took place between November 2014 and November 2015. The study collected population-based data on demographics, healthcare utilization, height, weight, blood pressure (BP) and blood glucose as well as HIV infection, HIV-1 RNA viral load (VL) and ART exposure. We used regression models to determine whether HIV care cascade stage (HIV-negative, HIV+ /No ART, ART/Detected HIV VL, and ART/Undetectable VL) was associated with diagnosis or treatment of hypertension or diabetes, and systolic blood pressure and glucose among those with diagnosed hypertension or diabetes. ART use was measured from drug level testing on dried blood spots. RESULTS AND DISCUSSION Compared to people without HIV, ART/Undetectable VL was associated with greater awareness of hypertension diagnosis (adjusted risk ratio (aRR) 1.18, 95% CI: 1.09 to 1.28) and treatment of hypertension (aRR 1.24, 95% CI: 1.10 to 1.41) among those who met hypertension diagnostic criteria. HIV care cascade stage was not significantly associated with awareness of diagnosis or treatment of diabetes. Among those with diagnosed hypertension or diabetes, ART/Undetectable VL was associated with lower mean systolic blood pressure (5.98 mm Hg, 95% CI: 9.65 to 2.32) and lower mean glucose (3.77 mmol/L, 95% CI: 6.85 to 0.69), compared to being HIV-negative. CONCLUSIONS Participants on ART with an undetectable VL had lower systolic blood pressure and blood glucose than the HIV-negative participants. HIV treatment programmes may provide a platform for health systems strengthening for cardiometabolic disease.
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Affiliation(s)
- Jennifer Manne‐Goehler
- Division of Infectious DiseasesMassachusetts General HospitalHarvard Medical SchoolBostonMAUSA
- Department of Global Health & PopulationHarvard T.H. Chan School of Public HealthBostonMAUSA
| | - Mark J Siedner
- Massachusetts General HospitalHarvard Medical SchoolBostonMAUSA
| | - Livia Montana
- Harvard Center for Population & Development StudiesHarvard UniversityCambridgeMAUSA
| | - Guy Harling
- Harvard Center for Population & Development StudiesHarvard UniversityCambridgeMAUSA
- Africa Health Research Institute (AHRI)MtubatubaSouth Africa
- Institute for Global HealthUniversity College LondonLondonUK
| | - Pascal Geldsetzer
- Department of Global Health & PopulationHarvard T.H. Chan School of Public HealthBostonMAUSA
| | - Julia Rohr
- Harvard Center for Population & Development StudiesHarvard UniversityCambridgeMAUSA
| | - F Xavier Gómez‐Olivé
- Medical Research Council/Wits Rural Public Health & Health Transitions Research UnitSchool of Public HealthUniversity of the WitwatersrandJohannesburgSouth Africa
- INDEPTH NetworkAccraGhana
| | - Alexander Goehler
- Department of Radiology, Brigham & Women's HospitalHarvard Medical SchoolBostonMAUSA
| | - Alisha Wade
- Medical Research Council/Wits Rural Public Health & Health Transitions Research UnitSchool of Public HealthUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Thomas Gaziano
- Department of Cardiovascular MedicineBrigham & Women's HospitalHarvard Medical SchoolBostonMAUSA
- Center for Health Decision ScienceHarvard Medical SchoolBostonMAUSA
| | - Kathleen Kahn
- Medical Research Council/Wits Rural Public Health & Health Transitions Research UnitSchool of Public HealthUniversity of the WitwatersrandJohannesburgSouth Africa
- INDEPTH NetworkAccraGhana
| | - Justine I Davies
- Medical Research Council/Wits Rural Public Health & Health Transitions Research UnitSchool of Public HealthUniversity of the WitwatersrandJohannesburgSouth Africa
- Centre for Global HealthKing's College LondonLondonUK
| | - Stephen Tollman
- Medical Research Council/Wits Rural Public Health & Health Transitions Research UnitSchool of Public HealthUniversity of the WitwatersrandJohannesburgSouth Africa
- INDEPTH NetworkAccraGhana
| | - Till W Bärnighausen
- Department of Global Health & PopulationHarvard T.H. Chan School of Public HealthBostonMAUSA
- Africa Health Research Institute (AHRI)MtubatubaSouth Africa
- Institute of Public HealthUniversity of HeidelbergHeidelbergGermany
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Recovery of metabolic impairment in patients who cleared chronic hepatitis C infection after direct-acting antiviral therapy. Int J Antimicrob Agents 2018; 53:559-563. [PMID: 30550818 DOI: 10.1016/j.ijantimicag.2018.11.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 11/19/2018] [Accepted: 11/24/2018] [Indexed: 02/06/2023]
Abstract
Chronic hepatitis C (CHC) is a complex disease that can affect different metabolic processes, including glucose and lipid metabolic pathways, with a significant impact on the development of heart disease and stroke. Recent therapy with direct-acting antivirals (DAAs), beyond its high efficacy on CHC eradication, showed a beneficial impact on glucose and lipid metabolism. This review aimed to describe current evidence regarding the association between hepatitis C virus (HCV) infection and impairment of glucose and lipid metabolism and also discusses potential public-health implications in light of the new DAA therapies and their availability at a global level. The excellent safety profile and efficacy of DAAs offer an exceptional opportunity to control the HCV pandemic at a global level and represent an opportunity for developing an operational research framework aimed at investigating the complex dynamics between host, pathogen and therapy that lead to metabolic damage in subjects with infectious diseases.
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Rigato M, Pizzol D, Tiago A, Putoto G, Avogaro A, Fadini GP. Characteristics, prevalence, and outcomes of diabetic foot ulcers in Africa. A systemic review and meta-analysis. Diabetes Res Clin Pract 2018; 142:63-73. [PMID: 29807105 DOI: 10.1016/j.diabres.2018.05.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 04/22/2018] [Accepted: 05/09/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Among non-communicable diseases, diabetes represents a growing public health problem in Africa, where diabetes-related needs remain mostly unmet and the disabling features of foot are worsened by hygienic, cultural, and healthcare issues. We aimed to review clinical characteristics, prevalence, and outcomes of patients with diabetic foot ulcer in Africa. METHODS We searched the literature for cross-sectional and longitudinal studies reporting the characteristics of patients with diabetic foot in African countries, with a particular focus on ulcer prevalence, amputation rate, and mortality. FINDINGS Fifty-five full-text papers and ten abstracts were retrieved, reporting data from 19 African countries on 56,173 diabetic patients. According to the data collected, the overall prevalence of foot ulcers was 13% and increased over time, especially since 2001. Approximately 15% of patients with foot lesions underwent major amputation and 14.2% died during hospitalization. In patients with diabetic ulcers, insulin therapy was uncommon and neuropathy was the most common predisposing factor, but the prevalence of peripheral arterial disease correlated with amputation rates. Amputation and mortality decreased over time, probably as result of the implementation of screening programs in the last ten years. Mortality was directly related to previous amputation. INTERPRETATION The diabetic foot disease in Africa is a growing problem and is burden by high rate of in-hospital mortality. Educational interventions and screening programs including evaluation of the vascular status may play a crucial role to counter diabetic foot disease in Africa.
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Affiliation(s)
- Mauro Rigato
- Department of Medicine, University of Padova, Padova, Italy
| | | | | | | | - Angelo Avogaro
- Department of Medicine, University of Padova, Padova, Italy
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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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Atun R, Davies JI, Gale EAM, Bärnighausen T, Beran D, Kengne AP, Levitt NS, Mangugu FW, Nyirenda MJ, Ogle GD, Ramaiya K, Sewankambo NK, Sobngwi E, Tesfaye S, Yudkin JS, Basu S, Bommer C, Heesemann E, Manne-Goehler J, Postolovska I, Sagalova V, Vollmer S, Abbas ZG, Ammon B, Angamo MT, Annamreddi A, Awasthi A, Besançon S, Bhadriraju S, Binagwaho A, Burgess PI, Burton MJ, Chai J, Chilunga FP, Chipendo P, Conn A, Joel DR, Eagan AW, Gishoma C, Ho J, Jong S, Kakarmath SS, Khan Y, Kharel R, Kyle MA, Lee SC, Lichtman A, Malm CP, Mbaye MN, Muhimpundu MA, Mwagomba BM, Mwangi KJ, Nair M, Niyonsenga SP, Njuguna B, Okafor OLO, Okunade O, Park PH, Pastakia SD, Pekny C, Reja A, Rotimi CN, Rwunganira S, Sando D, Sarriera G, Sharma A, Sidibe A, Siraj ES, Syed AS, Van Acker K, Werfalli M. Diabetes in sub-Saharan Africa: from clinical care to health policy. Lancet Diabetes Endocrinol 2017; 5:622-667. [PMID: 28688818 DOI: 10.1016/s2213-8587(17)30181-x] [Citation(s) in RCA: 284] [Impact Index Per Article: 40.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 04/10/2017] [Accepted: 05/02/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Rifat Atun
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA.
| | - Justine I Davies
- Centre for Global Health, King's College London, Weston Education Centre, London, UK; MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Education Campus, University of Witwatersrand, Parktown, South Africa
| | | | - Till Bärnighausen
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA; Institute of Public Health, Faculty of Medicine, Heidelberg University, Heidelberg, Germany; Africa Health Research Institute, KwaZulu, South Africa
| | - David Beran
- Division of Tropical and Humanitarian Medicine, University of Geneva and Geneva University Hospitals, Geneva, Switzerland
| | - Andre Pascal Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Naomi S Levitt
- Division of Diabetic Medicine & Endocrinology, University of Cape Town, Cape Town, South Africa; Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Moffat J Nyirenda
- Department of NCD Epidemiology, London School of Hygiene and Tropical Medicine, London, UK; NCD Theme, MRC/UVRI Uganda Research Unit, Entebbe, Uganda
| | - Graham D Ogle
- International Diabetes Federation Life for a Child Program, Glebe, NSW, Australia; Diabetes NSW & ACT, Glebe, NSW, Australia
| | | | - Nelson K Sewankambo
- Department of Medicine, and Clinical Epidemiology Unit, Makerere University College of Health Sciences, Kampala, Uganda
| | - Eugene Sobngwi
- University of Newcastle at Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Solomon Tesfaye
- Sheffield Teaching Hospitals and University of Sheffield, Royal Hallamshire Hospital, Sheffield, UK
| | - John S Yudkin
- Institute of Cardiovascular Science, Division of Medicine, University College London, London, UK
| | - Sanjay Basu
- Center for Population Health Sciences and Center for Primary Care and Outcomes Research, Department of Medicine and Department of Health Research and Policy, Stanford University, Palo Alto, CA, USA
| | - Christian Bommer
- University of Goettingen, Centre for Modern Indian Studies & Department of Economics, Goettingen, Germany
| | - Esther Heesemann
- University of Goettingen, Centre for Modern Indian Studies & Department of Economics, Goettingen, Germany
| | - Jennifer Manne-Goehler
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA; Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Iryna Postolovska
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Vera Sagalova
- University of Goettingen, Centre for Modern Indian Studies & Department of Economics, Goettingen, Germany
| | - Sebastian Vollmer
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA; University of Goettingen, Centre for Modern Indian Studies & Department of Economics, Goettingen, Germany
| | - Zulfiqarali G Abbas
- Muhimbili University of Health and Allied Sciences, and Abbas Medical Centre, Dar es Salaam, Tanzania
| | - Benjamin Ammon
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | - Akhila Annamreddi
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Ananya Awasthi
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | | | - Agnes Binagwaho
- Harvard Medical School, Harvard University, Boston, MA, USA; Geisel School of Medicine at Dartmouth, Hanover, NH, USA; University of Global Health Equity, Kigali, Rwanda
| | | | - Matthew J Burton
- International Centre for Eye Health, Faculty of Infectious & Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Jeanne Chai
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Felix P Chilunga
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | | | - Anna Conn
- The Fletcher School of Law and Diplomacy, Tufts University, Medford, MA, USA
| | - Dipesalema R Joel
- Department of Paediatrics and Adolescent Health, Faculty of Medicine, University of Botswana and Princess Marina Hospital, Gaborone, Botswana
| | - Arielle W Eagan
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA
| | | | - Julius Ho
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Simcha Jong
- Leiden University, Science Based Business, Leiden, Netherlands
| | - Sujay S Kakarmath
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | - Ramu Kharel
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA; University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Michael A Kyle
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Seitetz C Lee
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Amos Lichtman
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | - Maïmouna N Mbaye
- Clinique Médicale II, Centre de diabétologie Marc Sankale, Hôpital Abass Ndao, Dakar, Senegal
| | - Marie A Muhimpundu
- The Institute of HIV/AIDS, Disease Prevention & Control, Rwanda Biomedical Center, Kigali, Rwanda
| | | | | | - Mohit Nair
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Simon P Niyonsenga
- The Institute of HIV/AIDS, Disease Prevention & Control, Rwanda Biomedical Center, Kigali, Rwanda
| | | | - Obiageli L O Okafor
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Oluwakemi Okunade
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Paul H Park
- Partners In Health, Rwinkwavu, South Kayonza, Rwanda
| | - Sonak D Pastakia
- Purdue University College of Pharmacy (Purdue Kenya Partnership), Indiana Institute for Global Health, Uasin Gishu, Kenya
| | | | - Ahmed Reja
- Department of Internal Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Charles N Rotimi
- Center for Research on Genomics and Global Health, National Institutes of Health, Bethesda, MD, USA
| | - Samuel Rwunganira
- The Institute of HIV/AIDS, Disease Prevention & Control, Rwanda Biomedical Center, Kigali, Rwanda
| | - David Sando
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | - Anshuman Sharma
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | | | - Azhra S Syed
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Kristien Van Acker
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Mahmoud Werfalli
- Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
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