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Ebasone PV, Dzudie A, Peer N, Hoover D, Shi Q, Kim HY, Brazier E, Ajeh R, Yotebieng M, Nash D, Anastos K, Kengne AP. Coprevalence and associations of diabetes mellitus and hypertension among people living with HIV/AIDS in Cameroon. AIDS Res Ther 2024; 21:36. [PMID: 38824579 PMCID: PMC11144319 DOI: 10.1186/s12981-024-00624-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 05/22/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND The association between HIV infection and increased cardiometabolic risk, attributed to chronic inflammation in people living with HIV (PLWH) and/or antiretroviral therapy (ART) effects, has been inconsistent. In this study, we aimed to assess the associations of HIV-related factors with hypertension (HTN) and type-2 diabetes mellitus (T2DM), and the potential mediation effects of body mass index (BMI) in the associations between ART use and HTN or T2DM in PLWH in Cameroon. METHODS A cross-sectional study was conducted with 14,119 adult PLWH from Cameroon enrolled in the International epidemiology Databases to Evaluate AIDS (IeDEA) between 2016 and 2021. HTN was defined as systolic/diastolic blood pressure ≥ 140/90 mmHg and/or current use of antihypertensive medication, while T2DM was defined as fasting blood sugar ≥ 126 mg/dL and/or use of antidiabetic medications. Univariable and multivariable multinomial logistic regression analyses examined the associations of factors with HTN alone, T2DM alone, and both (HTN + T2DM). Mediation analyses were conducted to assess the potential mediation roles of BMI, while controlling for age, sex, and smoking. RESULTS Of the 14,119 participants, 9177 (65%) were women, with a median age of 42 (25th-75th percentiles: 35-51) years. Age > 50 years was associated with HTN alone, T2DM alone, and HTN + T2DM compared to the age group 19-29 years. Men had higher odds of having HTN + T2DM. Overweight and obesity were predictors of HTN alone compared to being underweight. WHO stages II and III HIV disease were inversely associated with HTN alone compared to stage I. The odds of diabetes alone were lower with ART use. BMI partially mediated the association between ART use and hypertension, with a proportion of mediation effect of 49.6% (all p < 0.02). However, BMI did not mediate the relationship between ART use and diabetes. CONCLUSIONS Traditional cardiovascular risk factors were strongly associated with hypertension among PLWH, while HIV-related exposures had smaller associations. BMI partially mediated the association between ART use and hypertension. This study emphasizes the importance of screening, monitoring, and managing HTN and T2DM in older, male, and overweight/obese PLWH. Further research on the associations of HIV disease stage and ART use with HTN and T2DM is warranted.
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Affiliation(s)
- Peter Vanes Ebasone
- Department of Medicine, University of Cape Town, Cape Town, South Africa.
- Clinical Research Education Networking and Consultancy (CRENC), Yaounde, Cameroon.
| | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy (CRENC), Yaounde, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
- Lown Scholars Program, Harvard T. H. Chan School of Public Health, Boston, USA
| | - Nasheeta Peer
- Department of Medicine, University of Cape Town, Cape Town, South Africa
- Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Donald Hoover
- Department of Statistics and Institute for Health, Health Care Policy and Aging Research, Rutgers the State University of New Jersey, New Brunswick, USA
| | - Qiuhu Shi
- Department of Public Health, New York Medical College, New York, USA
| | - Hae-Young Kim
- Department of Public Health, New York Medical College, New York, USA
| | - Ellen Brazier
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
- Department of Epidemiology and Biostatistics, Graduate School of Public Health, City University of New York, New York, USA
| | - Rogers Ajeh
- Clinical Research Education Networking and Consultancy (CRENC), Yaounde, Cameroon
- Ministry of Public Health, National AIDS Control Committee, Yaounde, Cameroon
| | - Marcel Yotebieng
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
- Department of Epidemiology and Biostatistics, Graduate School of Public Health, City University of New York, New York, USA
| | - Kathryn Anastos
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Andre Pascal Kengne
- Department of Medicine, University of Cape Town, Cape Town, South Africa
- Clinical Research Education Networking and Consultancy (CRENC), Yaounde, Cameroon
- Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
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Nazari I, Feinstein MJ. Evolving mechanisms and presentations of cardiovascular disease in people with HIV: implications for management. Clin Microbiol Rev 2024; 37:e0009822. [PMID: 38299802 PMCID: PMC10938901 DOI: 10.1128/cmr.00098-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024] Open
Abstract
People with HIV (PWH) are at elevated risk for cardiovascular diseases (CVDs), including myocardial infarction, heart failure, and sudden cardiac death, among other CVD manifestations. Chronic immune dysregulation resulting in persistent inflammation is common among PWH, particularly those with sustained viremia and impaired CD4+ T cell recovery. This inflammatory milieu is a major contributor to CVDs among PWH, in concert with common comorbidities (such as dyslipidemia and smoking) and, to a lesser extent, off-target effects of antiretroviral therapy. In this review, we discuss the clinical and mechanistic evidence surrounding heightened CVD risks among PWH, implications for specific CVD manifestations, and practical guidance for management in the setting of evolving data.
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Affiliation(s)
- Ilana Nazari
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Matthew J. Feinstein
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Cardiology in the Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Uwanyirigira D, Biracyaza E, Uzabakiriho I, Omolo J, Hakizayezu F, Nzayirambaho M. Prevalence and Factors Associated with Hypertension Among HIV Positive Patients on Antiretroviral Therapy: A Hospital-Based Cross-Sectional Study in Rwanda. Vasc Health Risk Manag 2023; 19:857-870. [PMID: 38162226 PMCID: PMC10757801 DOI: 10.2147/vhrm.s442108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/21/2023] [Indexed: 01/03/2024] Open
Abstract
Introduction The human immunodeficiency virus (HIV) and the use of antiretroviral therapy (ART) are influential elements contributing to hypertension, which is a public health concern particularly in sub-Saharan Africa where its underdiagnosis and limited investigation persist. Moreover, hypertension prevails at higher rates among individuals living with HIV (PLWH) in comparison to the general population. Therefore, our study determined the prevalence of hypertension and its associated factors among PLWH who are undergoing ART treatment at Byumba District Hospital. Methods A cross-sectional study design was conducted among 406 PLWH over the age of 14 years who were undergoing ART within the HIV department. We performed statistical analyses using STATA version 13. Significant independent variables identified in the bivariate analysis were further exported in a multivariable logistic regression model to ascertain their association with hypertension. This model elucidated factors associated with hypertension, presenting outcomes through odds ratios and their respective 95% confidence intervals, with statistical significance set at p < 0.05. Results The prevalence of hypertension was 24.7%, which means that roughly 1 in 4 PLWH were hypertensive. Notably, individuals aged 41 years and above demonstrated a significant association with heightened hypertension [AOR = 4.49; 95% CI = 2.45-8.21, p < 0.001] in contrast to those aged between 14 and 40 years. Additionally, smokers [AOR = 12.12; 95% CI = 4.48-32.74, p < 0.001] and individuals with a family history of hypertension [AOR = 4.28; 95% CI = 1.01-18.13, p = 0.049] demonstrated a higher likelihood of hypertension than their counterparts. Moreover, alcohol consumers [AOR = 5.5; 95% CI = 2.75-10.9, p < 0.001] had an increased likelihoods of hypertension compared to non-drinkers. Lastly, diabetics were almost 6 times more likely to be hypotensive [AOR = 4.50; 95% CI = 2.55-7.95, p = 0.018] when compared to those without diabetes. Conclusion Our findings strongly underscore the urgency for the implementation of targeted programs aimed at enhancing awareness and comprehension of the factors and potential complications tied to hypertension among PLWH. Such programs could be integrated into routine HIV care services to provide patients with the information and skills required to manage their hypertension effectively.
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Affiliation(s)
- Donatha Uwanyirigira
- Department of Epidemiology and Biostatistics, University of Rwanda, Kigali, Rwanda
- Byumba District Hospital, Ministry of Health, Byumba, Rwanda
| | - Emmanuel Biracyaza
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Quebec, Montréal
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Institut Universitaire Sur la Réadaptation En Déficience Physique de Montréal, Quebec, Canada
| | | | - Jared Omolo
- Field Epidemiology Training Program (FELTP), Centers for Disease Control and Prevention (CDC) in Rwanda, Kigali, Rwanda
| | - François Hakizayezu
- Department of Epidemiology and Biostatistics, University of Rwanda, Kigali, Rwanda
| | - Manasse Nzayirambaho
- Department of Epidemiology and Biostatistics, University of Rwanda, Kigali, Rwanda
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Moyo-Chilufya M, Maluleke K, Kgarosi K, Muyoyeta M, Hongoro C, Musekiwa A. The burden of non-communicable diseases among people living with HIV in Sub-Saharan Africa: a systematic review and meta-analysis. EClinicalMedicine 2023; 65:102255. [PMID: 37842552 PMCID: PMC10570719 DOI: 10.1016/j.eclinm.2023.102255] [Citation(s) in RCA: 2] [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: 05/13/2023] [Revised: 09/18/2023] [Accepted: 09/18/2023] [Indexed: 10/17/2023] Open
Abstract
Background Non-communicable diseases (NCDs) are increasing among people living with HIV (PLHIV), especially in Sub-Saharan Africa (SSA). We determined the prevalence of NCDs and NCD risk factors among PLHIV in SSA to inform health policy makers. Methods We conducted a systematic review and meta-analysis on the prevalence of NCDs and risk factors among PLHIV in SSA. We comprehensively searched PubMed/MEDLINE, Scopus, and EBSCOhost (CINAHL) electronic databases for sources published from 2010 to July 2023. We applied the random effects meta-analysis model to pool the results using STATA. The systematic review protocol was registered on PROSPERO (registration number: CRD42021258769). Findings We included 188 studies from 21 countries in this meta-analysis. Our findings indicate pooled prevalence estimates for hypertension (20.1% [95% CI:17.5-22.7]), depression (30.4% [25.3-35.4]), diabetes (5.4% [4.4-6.4]), cervical cancer (1.5% [0.1-2.9]), chronic respiratory diseases (7.1% [4.0-10.3]), overweight/obesity (32.2% [29.7-34.7]), hypercholesterolemia (21.3% [16.6-26.0]), metabolic syndrome (23.9% [19.5-28.7]), alcohol consumption (21.3% [17.9-24.6]), and smoking (6.4% [5.2-7.7]). Interpretation People living with HIV have a high prevalence of NCDs and their risk factors including hypertension, depression, overweight/obesity, hypercholesterolemia, metabolic syndrome and alcohol consumption. We recommend strengthening of health systems to allow for improved integration of NCDs and HIV services in public health facilities in SSA. NCD risk factors such as obesity, hypercholesterolemia, and alcohol consumption can be addressed through health promotion campaigns. There is a need for further research on the burden of NCDs among PLHIV in most of SSA. Funding This study did not receive any funding.
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Affiliation(s)
- Maureen Moyo-Chilufya
- Faculty of Health Sciences, School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Kuhlula Maluleke
- Faculty of Health Sciences, School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Kabelo Kgarosi
- Faculty of Health Sciences, School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Monde Muyoyeta
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Charles Hongoro
- Faculty of Health Sciences, School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
- Human Sciences Research Council, Pretoria, South Africa
| | - Alfred Musekiwa
- Faculty of Health Sciences, School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
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Badru OA, Bain LE, Adeagbo OA. Does adherence to antiretroviral therapy differ by place of residence in Nigeria? A systematic review and meta-analysis protocol. BMJ Open 2023; 13:e070024. [PMID: 37491090 PMCID: PMC10373693 DOI: 10.1136/bmjopen-2022-070024] [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: 07/27/2023] Open
Abstract
INTRODUCTION Retention in care is still a significant challenge in the HIV treatment cascade and varies extensively across regions, leading to poor adherence to antiretroviral therapy (ART). Several factors across different socioecological levels, such as health and community-level factors, inhibit ART adherence among people living with HIV (PLWH) in Nigeria. This review seeks to ask whether adherence to ART differs by place of residence in Nigeria. METHOD AND ANALYSIS This systematic review and meta-analysis will follow the updated Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. We will search PubMed, SCOPUS, CINAHL, Web of Science, MEDLINE (Ovid) and Google Scholar from onset to 30 April 2023. We will include only quantitative observational studies or mixed-method studies that measured the association between place of residence (urban and rural) and adherence to ART among PLWH aged ≥15 years. Title and abstract screening, full-text screening, data extraction and quality assessment will be done by two reviewers independently. A third reviewer will resolve disagreements. We will extract the author's name and year of publication, study aim(s), participant's characteristics, sample size, sampling method, region and state, adherence definition and adherence level in urban and rural areas. Data will be analysed with Review Manager V.5.4. The Q statistical test will be used to assess between-study heterogeneity, while Higgins and Thompson's I2 will be used to quantify the heterogeneity level. Several subgroups and sensitivity analyses will be conducted. ETHICS AND DISSEMINATION Ethical approval is not warranted for this study since primary published data will be utilised. The findings of this review will be published in a high-impact peer-reviewed journal and presented at a conference. PROSPERO REGISTRATION NUMBER CRD42022371965.
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Affiliation(s)
| | - Luchuo Engelbert Bain
- Department of Psychology, University of Johannesburg, Auckland, Johannesburg, South Africa
- International Development Research Centre (IDRC), Ottawa, Ontario, Canada
| | - Oluwafemi Atanda Adeagbo
- Community and Behavioral Health, University of Iowa, Iowa City, Iowa, USA
- Department of Sociology, University of Johannesburg, Kingsway Campus, Johannesburg, South Africa
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Significant Others and Not Family or Friend Support Mediate Between Stigma and Discrimination Among People Living With HIV in Lagos State, Nigeria: A Cross-sectional Study. J Assoc Nurses AIDS Care 2023; 34:96-104. [PMID: 36198119 DOI: 10.1097/jnc.0000000000000366] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
ABSTRACT Approximately 70% of the 37.7 million people living with HIV (PLWH) globally reside in sub-Saharan Africa and 10% of the global HIV burden is in Nigeria. PLWH encounter stigma and discrimination. Limited support from family, friends, and significant others increases stigma and discrimination among PLWH. This study sought to understand how support from family, friends, and significant others mediates stigma and discrimination in the Nigerian context. This descriptive cross-sectional study enrolled 396 PLWH from six health facilities between June and July 2021 in Lagos State, Nigeria. Stigma, discrimination, and social support were assessed. On average, participants were 32 years of age and female. Increased social support was associated with reduced stigma and discrimination. Support from participants' significant others was found to mediate the relationship between stigma and discrimination.
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Harimenshi D, Niyongabo T, Preux PM, Aboyans V, Desormais I. Hypertension and associated factors in HIV-infected patients receiving antiretroviral treatment in Burundi: a cross-sectional study. Sci Rep 2022; 12:20509. [PMID: 36443478 PMCID: PMC9705296 DOI: 10.1038/s41598-022-24997-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022] Open
Abstract
Currently, the life expectancy of people living with the human immunodeficiency virus (HIV) and the general population are similar. Hypertension is a major public health issue in Africa and is largely underdiagnosed. Most HIV-infected individuals, especially those on Anti-Retroviral Therapy (ART) have hypertension. Our project aims to determine the prevalence of hypertension and associated factors amongst HIV-infected adults treated by ART in Burundi. A cross-sectional study was conducted among HIV-infected subjects over the age of 20, managed in five healthcare centers for people living with HIV (PLWH). The World Health Organization STEPWISE survey and anthropometric measurements were employed. Blood pressure was measured according to the ESC 2018 recommendations. 1 250 HIV-infected patients aged between 35.4 and 50.2 years were included (18.4% men). The prevalence of hypertension was 17.4% (95% CI 13.2-22.1). Approximately 47.25% of HIV patients with hypertension were previously undiagnosed. Other factors were associated with HTN, such as being overweight (OR 2.88; 95% CI 1.46-5.62), obesity (OR 2.65; 95% CI 1.27-5.55), longer duration of HIV infection: ≥ 10 years (OR 1.04; 95% CI 1.14-3.20), diabetes (OR 2.1; 95% CI 1.37-3.32) and age (OR 1.13; 95% CI 1.09-1.14). Despite their young age, almost 20% of HIV-ART treated patients had hypertension, 50% of these were undiagnosed. Blood pressure monitoring is crucial in these patients, especially those identified as high-risk, with prompt life and disability-saving interventions.
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Affiliation(s)
- Déo Harimenshi
- grid.9966.00000 0001 2165 4861Inserm U1094, IRD U270, CHU Limoges, EpiMaCT-Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, University of Limoges, Limoges, France
| | - Théodore Niyongabo
- grid.7749.d0000 0001 0723 7738Department of Internal Medicine, CHU Kamenge, University of Burundi, Bujumbura, Burundi
| | - Pierre-Marie Preux
- grid.9966.00000 0001 2165 4861Inserm U1094, IRD U270, CHU Limoges, EpiMaCT-Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, University of Limoges, Limoges, France
| | - Victor Aboyans
- grid.9966.00000 0001 2165 4861Inserm U1094, IRD U270, CHU Limoges, EpiMaCT-Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, University of Limoges, Limoges, France ,grid.411178.a0000 0001 1486 4131Department of Cardiology, CHU Limoges, Limoges, France
| | - Ileana Desormais
- grid.9966.00000 0001 2165 4861Inserm U1094, IRD U270, CHU Limoges, EpiMaCT-Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, University of Limoges, Limoges, France ,grid.411178.a0000 0001 1486 4131Department of Vascular Surgery and Vascular Medicine, CHU Limoges, Limoges, France
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