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Maron BA, Bortman G, De Marco T, Huston JH, Lang IM, Rosenkranz SH, Vachiéry JL, Tedford RJ. Pulmonary hypertension associated with left heart disease. Eur Respir J 2024:2401344. [PMID: 39209478 DOI: 10.1183/13993003.01344-2024] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Accepted: 07/11/2024] [Indexed: 09/04/2024]
Abstract
Left heart disease (LHD) is the most common cause of pulmonary hypertension (PH), which may be classified further as isolated post-capillary (ipcPH) or combined post- and pre-capillary PH (cpcPH). The 7th World Symposium on Pulmonary Hypertension PH-LHD task force reviewed newly reported randomised clinical trials and contemplated novel opportunities for improving outcome. Results from major randomised clinical trials reinforced prior recommendations against the use of pulmonary arterial hypertension therapy in PH-LHD outside of clinical trials, and suggested possible harm. Greater focus on phenotyping was viewed as one general strategy by which to ultimately improve clinical outcomes. This is potentially achievable by individualising ipcPH versus cpcPH diagnosis for patients with pulmonary arterial wedge pressure within a diagnostic grey zone (12-18 mmHg), and through a newly developed PH-LHD staging system. In this model, PH accompanies LHD across four stages (A=at risk, B=structural heart disease, C=symptomatic heart disease, D=advanced), with each stage characterised by progression in clinical characteristics, haemodynamics and potential therapeutic strategies. Along these lines, the task force proposed disaggregating PH-LHD to emphasise specific subtypes for which PH prevalence, pathophysiology and treatment are unique. This includes re-interpreting mitral and aortic valve stenosis through a contemporary lens, and focusing on PH within the hypertrophic cardiomyopathy and amyloid cardiomyopathy clinical spectra. Furthermore, appreciating LHD in the profile of PH patients with chronic lung disease and chronic thromboembolic pulmonary disease is essential. However, engaging LHD patients in clinical research more broadly is likely to require novel methodologies such as pragmatic trials and may benefit from next-generation analytics to interpret results.
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Affiliation(s)
- Bradley A Maron
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
- The University of Maryland - Institute for Health Computing, Bethesda, MD, USA
| | - Guillermo Bortman
- Transplant Unit, Heart Failure and PH Program, Sanatorio Trinidad Mitre and Sanatorio Trinidad Palermo, Buenos Aires, Argentina
| | - Teresa De Marco
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | | | - Irene M Lang
- Medical University of Vienna AUSTRIA Center of Cardiovascular Medicine, Vienna, Austria
| | - Stephan H Rosenkranz
- Department of Cardiology and Cologne Cardiovascular Research Center (CCRC), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jean-Luc Vachiéry
- HUB (Hopital Universitaire de Bruxelles) Erasme, Free University of Brussels, Brussels, Belgium
| | - Ryan J Tedford
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
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2
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van Heerden JK, Louw EH, Thienemann F, Engel ME, Allwood BW. The prevalence of pulmonary hypertension in post-tuberculosis and active tuberculosis populations: a systematic review and meta-analysis. Eur Respir Rev 2024; 33:230154. [PMID: 38232991 DOI: 10.1183/16000617.0154-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 11/23/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND The prevalence of tuberculosis (TB)-associated pulmonary hypertension (PH) has not previously been quantified, resulting in an underappreciated burden of disease. We aimed to estimate the prevalence of PH in post-TB and active TB populations. METHODS In this systematic review and meta-analysis, we searched PubMed/Medline, Cochrane Library, EBSCOhost, Scopus, African Journals Online and Google Scholar, with no language restriction, for available literature published after 1950. Eligible studies described adult participants (≥16 years), with documented evidence of active or prior TB, diagnosed with PH. Study quality was assessed using a risk of bias tool specifically developed for prevalence studies. Aggregate prevalence estimates with 95% confidence intervals were synthesised using a random-effects meta-analysis model, incorporating the Freeman-Tukey transformation. Subgroup analysis was conducted to ascertain prevalence estimates in specific patient populations. RESULTS We identified 1452 unique records, of which 34 met our inclusion criteria. 23 studies, with an acceptable risk of bias and where PH was diagnosed at right heart catheterisation or echocardiography, were included in the meta-analysis. In post-TB studies (14/23), the prevalence of PH was 67.0% (95% CI 50.8-81.4) in patients with chronic respiratory failure, 42.4% (95% CI 31.3-54.0) in hospitalised or symptomatic patients and 6.3% (95% CI 2.3-11.8) in nonhealthcare-seeking outpatients (I2=96%). There was a lower estimated prevalence of PH in studies of populations with active TB (9.4%, 95% CI 6.3-13.0), I2=84%). CONCLUSION Our results highlight the significant burden of PH in post-TB and active TB populations. We emphasise the need for increased recognition of TB-associated PH and additional high-quality prevalence data.
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Affiliation(s)
- Jennifer K van Heerden
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Elizabeth H Louw
- Division of Pulmonology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Friedrich Thienemann
- General Medicine and Global Health, Department of Medicine, and Cape Heart Institute, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
- Department of Internal Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Mark E Engel
- Department of Medicine, and Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- South African Medical Research Council, Cape Town, South Africa
| | - Brian W Allwood
- Division of Pulmonology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
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Nkoke C, Jingi AM, Noubiap JJ, Dzudie A. Pulmonary hypertension among patients hospitalized with acute heart failure in Buea, South West Region of Cameroon. Pan Afr Med J 2022; 42:216. [PMID: 36845244 PMCID: PMC9949280 DOI: 10.11604/pamj.2022.42.216.33076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 06/24/2022] [Indexed: 02/28/2023] Open
Abstract
Introduction pulmonary hypertension (PH) is a common and severe complication in patients with heart failure (HF). It is associated with increased morbidity and mortality. There is limited data in Cameroon on the prevalence of PH in hospitalized HF patients and its impact on outcome. Methods we analyzed data from consecutive adult patients hospitalized with. Pulmonary hypertension (PH) was defined as pulmonary artery systolic pressure (PASP) ≥ 35mmHg. Results eighty-six (86) consecutive patients were hospitalized and 66(76.7%) had measurable PASP on echocardiography. Of those with echocardiographically measurable PASP (66), there were 39 (59.1%) females. The median (IQR) age was 60 (42-76) years. The prevalence of PH was 93.9%. PH was present in all (100%) patients with right heart failure (RHF) and in 62 (93.9%) patients with left heart failure (LHF). Severe PH (PASP ≥55 mmHg) was seen in 45 (68.2%, [95% CI: 55.6-75.1]) patients. The mean PASP was significantly higher in those with isolated RHF compared with those who had isolated left or bi-ventricular failure. Factors likely associated with moderate-to-severe PH (PASP ≥ 45 mmHg) were female sex, RHF, and right atrial dilatation. After adjusting for sex, right atrial dilation was independently associated with moderate-to-severe PH. In-hospital death occurred in 7 (10.6%, [95% CI: 4.4-20.6]) patients. The median (IQR) time to death was 6 (3-7) days and ranged from 2 to 8 days. All deaths (100%) occurred in those with moderate-to-severe PH. Conclusion the prevalence of pulmonary hypertension in hospitalized heart failure patients was high with two third of the patients having severe PH, and most commonly occurred in females. All deaths occurred in patients with moderate-to-severe PH.
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Affiliation(s)
- Clovis Nkoke
- Faculty of Health Sciences, University of Buea, Buea, Cameroon,,Clinical Research Education, Networking and Consultancy, Douala, Cameroon,,Corresponding author: Clovis Nkoke, Faculty of Health Sciences, University of Buea, Buea, Cameroon.
| | | | - Jean Jacques Noubiap
- Centre for Heart Rhythm disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Anastase Dzudie
- Clinical Research Education, Networking and Consultancy, Douala, Cameroon,,Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
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Zhang L, Liu Y, Zhao S, Wang Z, Zhang M, Zhang S, Wang X, Zhang S, Zhang W, Hao L, Jiao G. The Incidence and Prevalence of Pulmonary Hypertension in the COPD Population: A Systematic Review and Meta-Analysis. Int J Chron Obstruct Pulmon Dis 2022; 17:1365-1379. [PMID: 35711174 PMCID: PMC9196913 DOI: 10.2147/copd.s359873] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 04/30/2022] [Indexed: 12/22/2022] Open
Abstract
Purpose Chronic obstructive pulmonary disease (COPD)-related pulmonary hypertension (PH) is one of the most common comorbidities of COPD, and often leads to a worse prognosis. Although the estimated prevalence and risk factors of COPD-related PH have been widely reported, these results have not been well integrated. This study aimed to review the worldwide incidence and prevalence of COPD-related PH and explore possible factors affecting its prevalence. Patients and Methods We searched four electronic databases (Web of Science, Embase, Cochrane, and MEDLINE) to identify all observational studies on the prevalence of COPD-related PH from database creation until July 20, 2021. Eligibility screening, quality assessment, and data extraction of the retrieved studies were independently conducted by two reviewers. Meta-analyses were performed to determine the prevalence of PH in the COPD population. Random-effects meta-regression model analyses were conducted to investigate the sources of heterogeneity. Results Altogether, 38 articles were included in the meta-analyses. The pooled prevalence was 39.2% (95% CI: 34.0–44.4, I2 = 97.6%) for COPD-related PH. Subgroup analyses showed that the prevalence of PH increased with COPD severity, where the majority (30.2%) had mild PH and the minority had severe PH (7.2%). Furthermore, we found a significant regional difference in the prevalence of COPD-related PH (P = 0.000), which was the highest in Africa (64.0%) and the lowest in Europe (30.4%). However, stratified studies on other factors involving mean age, sex, enrolment time, participant recruitment settings, and PH diagnostic methods showed no significant differences in prevalence (P >0.05). Conclusion The global incidence of PH in the COPD population is very high, and there are significant regional and international variations. Patients with COPD should be screened for PH and contributing risk factors to reduce the burden on individuals and society.
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Affiliation(s)
- Limin Zhang
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, People's Republic of China
| | - Yujia Liu
- College of Traditional Chinese Medicine, Liaoning University of Traditional Chinese Medicine, Shenyang, Liaoning, 110032, People's Republic of China
| | - Shuai Zhao
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, People's Republic of China
| | - Zhen Wang
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, People's Republic of China
| | - Miaomiao Zhang
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, People's Republic of China
| | - Su Zhang
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, People's Republic of China
| | - Xinzhuo Wang
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, People's Republic of China
| | - Shuang Zhang
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, People's Republic of China
| | - Wenyan Zhang
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, People's Republic of China
| | - Liying Hao
- Department of Pharmaceutical Pharmacology and Toxicology, China Medical University, Shenyang, Liaoning, 110000, People's Republic of China
| | - Guangyu Jiao
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, People's Republic of China
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Emmons‐Bell S, Johnson C, Boon‐Dooley A, Corris PA, Leary PJ, Rich S, Yacoub M, Roth GA. Prevalence, incidence, and survival of pulmonary arterial hypertension: A systematic review for the global burden of disease 2020 study. Pulm Circ 2022; 12:e12020. [PMID: 35506069 PMCID: PMC9052982 DOI: 10.1002/pul2.12020] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 10/13/2021] [Accepted: 11/03/2021] [Indexed: 11/13/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is characterized by increased resistance in the pulmonary arterioles as a result of remodeled blood vessels. We sought all available epidemiologic data on population‐based prevalence, incidence, and 1‐year survival of PAH as part of the Global Burden of Disease Study. We performed a systematic review searching Global Index Medicus (GIM) for keywords related to PAH between 1980 and 2021 and identified population‐representative sources of prevalence, incidence, and mortality for clinically diagnosed PAH. Of 6772 articles identified we found 65 with population‐level data: 17 for prevalence, 17 for incidence, and 58 reporting case fatality. Reported prevalence ranged from 0.37 cases/100,000 persons in a referral center of French children to 15 cases/100,000 persons in an Australian study. Reported incidence ranged from 0.008 cases/100,000 person‐years in Finland, to 1.4 cases/100,000 person‐years in a retrospective chart review at a clinic in Utah, United States. Reported 1‐year survival ranged from 67% to 99%. All studies with sex‐specific estimates of prevalence or incidence reported higher levels in females than males. Studies varied in their size, study design, diagnostic criteria, and sampling procedures. Reported PAH prevalence, incidence, and mortality varied by location and study. Prevalence ranged from 0.4 to 1.4 per 100,000 persons. Harmonization of methods for PAH registries would improve efforts at disease surveillance. Results of this search contribute to ongoing efforts to quantify the global burden of PAH.
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Affiliation(s)
- Sophia Emmons‐Bell
- Institute for Health Metrics and Evaluation University of Washington Seattle Washington USA
| | - Catherine Johnson
- Institute for Health Metrics and Evaluation University of Washington Seattle Washington USA
| | - Alexandra Boon‐Dooley
- Institute for Health Metrics and Evaluation University of Washington Seattle Washington USA
| | - Paul A. Corris
- Translational and Clinical Research Institute, Faculty of Medical Sciences Newcastle University Newcastle upon Tyne UK
- Pulmonary Vascular Research Institute UK
| | - Peter J. Leary
- Division of Pulmonary, Critical Care, and Sleep Medicine University of Washington Seattle Washington USA
| | - Stuart Rich
- Division of Cardiology Northwestern Memorial Hospital Chicago Illinois USA
| | - Magdi Yacoub
- Aswan Heart Centre Aswan Egypt
- National Heart & Lung Institute Imperial College London London UK
- Harefield Heart Science Centre London UK
| | - Gregory A. Roth
- Institute for Health Metrics and Evaluation University of Washington Seattle Washington USA
- Division of Cardiology, Department of Medicine University of Washington Seattle Washington USA
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Pulmonary Hypertension in Children across Africa: The Silent Threat. Int J Pediatr 2021; 2021:9998070. [PMID: 34858504 PMCID: PMC8632426 DOI: 10.1155/2021/9998070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 10/23/2021] [Indexed: 11/22/2022] Open
Abstract
Pulmonary hypertension (PH) is a complex puzzle in Africa, especially among children who present with a cocktail of issues including recurrent pulmonary infections, unoperated congenital heart disease, and advanced rheumatic heart disease. Sickle cell anemia and neonatal complications of transiting from fetal circulation also contribute to the burden of pulmonary hypertension. Mortality from pulmonary arterial hypertension (PAH) remains high in Africa (18-21%), claiming sufferers in the first 6 months after diagnosis. Unfortunately, PH remains underreported in sub-Saharan Africa since many centers lack the capacity to diagnose and confirm it by the recommended gold standard, right heart catheterization. The unresolved burden of unoperated congenital heart lesions and rheumatic heart disease, among other preventable causes, stand out as major causes of PH in African children. This paper highlights pediatric PAH as a result of major gaps in care and illustrates the need for its prevention as well as for the promotion of research into the most important drivers, to prevent premature mortality in the continent.
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Butrous G. Human Immunodeficiency Viruses and its effect on the Pulmonary Vascular bed. Am J Physiol Lung Cell Mol Physiol 2021; 321:L1062-L1066. [PMID: 34755531 DOI: 10.1152/ajplung.00451.2021] [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] [Indexed: 11/22/2022] Open
Abstract
December. 1st 2021 is "World AIDS Day" reminding us that HIV infection is still widespread and that many of its long-term effects can be deadly. One of these complications is its effect on the pulmonary vascular beds, leading to an increase in the pulmonary pressure, causing the clinical manifestation of "pulmonary hypertension". Unfortunately, we are still far from fully understanding the prevalence, mechanics, and pathobiology of "HIV pulmonary hypertension", especially in Africa and other developing countries where HIV is still common. In addition, the impact of other factors like co-infection and illicit drugs can add and modify the effect on the pulmonary vascular bed, complicating the pathological and clinical effects of HIV. Thus, "World AIDS Day" can be an impetus to pursue further research in this area.
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Affiliation(s)
- Ghazwan Butrous
- Medway School of Pharmacy, University of Kent, Canterbury, United Kingdom
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Chavez-Lindell T, Kikwe B, Gikonyo A, Odoi A. Patient characteristics and cardiac surgical outcomes at a tertiary care hospital in Kenya, 2008-2017: a retrospective study. PeerJ 2021; 9:e11191. [PMID: 34026344 PMCID: PMC8117927 DOI: 10.7717/peerj.11191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 03/09/2021] [Indexed: 11/20/2022] Open
Abstract
Background Cardiac surgeries are high risk procedures that require specialized care and access to these procedures is often limited in resource-poor countries. Although fatalities for surgical patients across Africa are twice that of the global rate, cardiac surgical mortality continent-wide is only slightly higher than all-surgical mortality. Understanding demographic and health characteristics of patients and the associations of these characteristics with morbidity and mortality events is important in guiding care decisions. Therefore, the objectives of this study were to: (a) describe the characteristics of cardiac surgical patients; (b) identify the associations between these characteristics and morbidity and mortality events following cardiac surgery. Methods Patient characteristics and post-surgical complications were abstracted for all cardiac surgical patients treated at a tertiary care hospital in Kenya from 2008 to 2017. Descriptive analyses of demographic factors, co-morbidities, peri-operative conditions, and post-surgical complications were conducted for adult and pediatric patients. Cochran-Armitage trend test was used to assess temporal trends in risk of death. Multivariable ordinary logistic and Firth logistic models were used to investigate predictors of surgical outcomes. Results The study included a total of 181 patients (150 adult and 31 pediatric patients). Most (91.3%) adult patients had acquired conditions while 45.2% of the pediatric patients had congenital defects. Adult patients tended to have co-morbid conditions including hypertension (16.7%), diabetes mellitus (7.3%), and nephropathy (6.7%). Most patients (76.0% adults and 96.8% pediatric patients) underwent ≤ 2 surgical procedures during their hospital stay. Seventy percent of adult and 54.8% of the pediatric patients experienced at least one post-surgical complication including mediastinal hemorrhage, acute kidney injury and death. Patient characteristics played the greatest roles in predicting post-surgical complications. For adult patients, significant predictors of acute kidney injury included atrial fibrillation (OR = 18.25; p = .001), mitral valve replacement (OR = 0.14; p = .019), and use of cardiopulmonary bypass (OR = 0.06; p = .002). Significant predictors of 30-day mortality were age (OR = 1.05; p = .015) and atrial fibrillation (OR = 4.12, p = .018). Although the number of surgeries increased over the decade-long study period, there were no significant (p = .467) temporal trends in the risk of death. Conclusions Awareness of demographic and peri-surgical factors that are predictors of complications is useful in guiding clinical decisions to reduce morbidity and mortality. Identification of co-morbidities as the most useful predictors of post-surgical complications suggests that patient characteristics may be a larger contributor to the incidence of complications than surgical practices.
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Affiliation(s)
- Tamara Chavez-Lindell
- Department of Biomedical and Diagnostic Sciences, University of Tennessee, Knoxville, TN, United States of America
| | | | | | - Agricola Odoi
- Department of Biomedical and Diagnostic Sciences, University of Tennessee, Knoxville, TN, United States of America
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Abstract
PURPOSE OF REVIEW Pulmonary hypertension is a deadly disease, the causes of which vary between geographical regions. Eighty four percentage of the world's population lives in majority countries (also called low-income and middle-income countries), yet data on pulmonary hypertension in these settings are proportionally scarce. This article provides a review of pulmonary hypertension in majority countries, focusing in detail on the most common causes in these regions, and highlights contextual challenges faced. RECENT FINDINGS Epidemiological data confirms a complex and overlapping array of causes, with pulmonary hypertension because of conditions such as rheumatic heart disease, HIV, schistosomiasis, chronic lung disease and sickle cell disease. Delayed pulmonary hypertension diagnosis remains a concern and is ascribed to a lack of resources and lack of pulmonary hypertension awareness by health professionals. Pulmonary hypertension diagnosis is frequently considered once signs of right heart failure emerge, while echocardiography and right heart catheterization are unavailable in many settings. Accurate data on the prevalence of pulmonary hypertension in many of these regions are needed and could be achieved by establishing and frequent review of national databases where the incident and prevalent pulmonary hypertension cases are captured. SUMMARY There is urgent need for pulmonary hypertension advocacy among clinicians in the primary, secondary and tertiary healthcare sectors of majority countries, and validated noninvasive diagnostic algorithms are needed. Increased awareness and early diagnosis are likely to improve outcomes of pulmonary hypertension patients in these regions, and potentially stimulate locally relevant research.
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Rajasekaran S, Rajasekar N, Sivanantham A. Therapeutic potential of plant-derived tannins in non-malignant respiratory diseases. J Nutr Biochem 2021; 94:108632. [PMID: 33794331 DOI: 10.1016/j.jnutbio.2021.108632] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 01/06/2021] [Accepted: 03/23/2021] [Indexed: 12/24/2022]
Abstract
Respiratory diseases are the major cause of human illness and death around the world. Despite advances in detection and treatment, very few classes of safe and effective therapy have been introduced to date. At present, phytochemicals are getting more attention because of their diverse beneficial activities and minimal toxicity. Tannins are polyphenolic secondary metabolites with high molecular weights, which are naturally present in a wide variety of fruits, vegetables, cereals, and leguminous seeds. Many tannins are endowed with well-recognized protective properties, such as anti-cancer, anti-microbial, anti-oxidant, anti-hyperglycemic, and many others. This review summarizes a large body of experimental evidence implicating that tannins are helpful in tackling a wide range of non-malignant respiratory diseases including acute lung injury (ALI), pulmonary fibrosis, asthma, pulmonary hypertension, and chronic obstructive pulmonary disease (COPD). Mechanistic pathways by which various classes of tannins execute their beneficial effects are discussed. In addition, clinical trials and our perspective on future research with tannins are also reviewed.
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Affiliation(s)
- Subbiah Rajasekaran
- Department of Biochemistry, ICMR-National Institute for Research in Environmental Health, Bhopal, Madhya Pradesh, India.
| | - Nandhine Rajasekar
- Department of Biotechnology, BIT-Campus, Anna University, Tiruchirappalli, Tamil Nadu, India
| | - Ayyanar Sivanantham
- Department of Biotechnology, BIT-Campus, Anna University, Tiruchirappalli, Tamil Nadu, India
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Neglected cardiovascular diseases and their significance in the Global North. Herz 2021; 46:129-137. [PMID: 33506326 DOI: 10.1007/s00059-021-05020-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2021] [Indexed: 10/22/2022]
Abstract
Due to increasing global migration, the spectrum of cardiovascular disease (CVD) is changing in developed countries. Up to 3% of migrants arriving in Europe have underlying CVD. Despite their high global prevalence, conditions such as rheumatic heart disease, Chagas disease, endomyocardial fibrosis, tuberculous pericarditis, peripartum cardiomyopathy, and pulmonary hypertension are often under-recognized, and, as a result, neglected in industrialized countries. Many of these conditions, and their causes, are often unfamiliar to the health-care providers in host countries. In this review, we summarize the epidemiology, etiology, clinical presentation, diagnostic work-up, and management of neglected CVDs that have an increasing prevalence in the Global North.
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Hasan B, Hansmann G, Budts W, Heath A, Hoodbhoy Z, Jing ZC, Koestenberger M, Meinel K, Mocumbi AO, Radchenko GD, Sallmon H, Sliwa K, Kumar RK. Challenges and Special Aspects of Pulmonary Hypertension in Middle- to Low-Income Regions: JACC State-of-the-Art Review. J Am Coll Cardiol 2020; 75:2463-2477. [PMID: 32408981 DOI: 10.1016/j.jacc.2020.03.047] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 03/19/2020] [Accepted: 03/23/2020] [Indexed: 01/19/2023]
Abstract
Challenges and special aspects related to the management and prognosis of pulmonary hypertension (PH) in middle- to low-income regions (MLIRs) range from late presentation to comorbidities, lack of resources and expertise, cost, and rare options of lung transplantation. Expert consensus recommendations addressing the specific challenges for prevention and therapy of PH in MLIRs with limited resources have been lacking. To date, 6 MLIR-PH registries containing mostly adult patients with PH exist. Importantly, the global prevalence of PH is much higher in MLIRs compared with high-income regions: group 2 PH (left heart disease), pulmonary arterial hypertension associated with unrepaired congenital heart disease, human immunodeficiency virus, or schistosomiasis are highly prevalent. This consensus statement provides selective, tailored modifications to the current PH guidelines to address the specific challenges faced in MLIRs, resulting in the first pragmatic and cost-effective consensus recommendations for PH care providers, patients, and their families.
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Affiliation(s)
- Babar Hasan
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan.
| | - Georg Hansmann
- Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Hannover, Germany.
| | - Werner Budts
- Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Alexandra Heath
- Division of Pediatric Cardiology, Kardiozentrum, La Paz, Bolivia
| | - Zahra Hoodbhoy
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Zhi-Cheng Jing
- Department of Cardiology, Peking Union Medical College Hospital & Key Lab of Pulmonary Vascular Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Martin Koestenberger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria
| | - Katharina Meinel
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria
| | - Ana Olga Mocumbi
- Instituto Nacional de Saúde, Vila de Marracuene, Maputo, Mozambique
| | - Ganna D Radchenko
- Secondary Hypertension Department with Pulmonary Hypertension Center, State Institute National Scientific Center, MD Strazhesko Institute of Cardiology of Ukrainian National Academy of Medical Science, and Bogomolets National Medical University, Kyiv, Ukraine
| | - Hannes Sallmon
- Department of Pediatric Cardiology, Charité University Medical Center, Berlin, Germany
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, Departments of Medicine and Cardiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - R Krishna Kumar
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
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Masenga SK, Elijovich F, Koethe JR, Hamooya BM, Heimburger DC, Munsaka SM, Laffer CL, Kirabo A. Hypertension and Metabolic Syndrome in Persons with HIV. Curr Hypertens Rep 2020; 22:78. [PMID: 32880756 PMCID: PMC7467859 DOI: 10.1007/s11906-020-01089-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW With the advent of highly active antiretroviral therapy (ART), the life span of persons with HIV (PWH) has been nearly normalized. With aging, prevalence of the metabolic syndrome (MetS), including hypertension, has increased in the HIV population and exceeds that in the general population in some studies. This is due to a combination of traditional risk factors in addition to the effects attributable to the virus and ART. We review recent findings on the mechanisms contributing to MetS and hypertension in PWH, particularly those specific to the viral infection and to ART. RECENT FINDINGS Activation of the renin-angiotensin-aldosterone system (RAAS) and chronic immune activation contribute to the development of MetS and hypertension in PWH. HIV proteins and some ART agents alter adipocyte health contributing to dyslipidemias, weight gain, and insulin resistance. HIV infection also contributes to hypertension by direct effects on the RAAS that intertwine with inflammation by the RAAS also contributing to T cell activation. Recent data suggest that in addition to current ART, therapeutic targeting of the MetS and hypertension in PWH, by interfering with the RAAS, treating insulin resistance directly or by use of immunomodulators that dampen inflammation, may be critical for preventing or treating these risk factors and to improve overall cardiovascular complications in the HIV-infected aging population.
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Affiliation(s)
- Sepiso K Masenga
- HAND Research group, School of Medicine and Health Sciences, Mulungushi University, Livingstone, Zambia
- Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Fernando Elijovich
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - John R Koethe
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Benson M Hamooya
- HAND Research group, School of Medicine and Health Sciences, Mulungushi University, Livingstone, Zambia
- School of Public Health, University of Zambia, Lusaka, Zambia
| | - Douglas C Heimburger
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Internal Medicine, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Sody M Munsaka
- Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Cheryl L Laffer
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Annet Kirabo
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
- Department of Molecular Physiology and Biophysics, Vanderbilt University School of Medicine, Room 536 Robinson Research Building, Nashville, TN, 37232-6602, USA.
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14
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Colebunders R, Siewe Fodjo JN, Vanham G, Van den Bergh R. A call for strengthened evidence on targeted, non-pharmaceutical interventions against COVID-19 for the protection of vulnerable individuals in sub-Saharan Africa. Int J Infect Dis 2020; 99:482-484. [PMID: 32861825 PMCID: PMC7451006 DOI: 10.1016/j.ijid.2020.08.060] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 08/14/2020] [Accepted: 08/22/2020] [Indexed: 12/12/2022] Open
Abstract
Curbing the transmission of SARS-CoV-2, the causative agent of COVID-19, may be difficult in sub-Saharan Africa. Overall COVID-19-related mortality remains low because of the young population. Protecting vulnerable individuals from severe disease should be a priority.
Following the easing of lockdown measures in many sub-Saharan African countries, coronavirus disease 2019 (COVID-19) cases have been on the rise. As the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of COVID-19, may be difficult to stop in these settings, we propose that the existing COVID-19 prevention strategies aimed at reducing overall transmission are complemented with more targeted strategies to protect people at risk of severe COVID-19 disease. We suggest investigating the feasibility, acceptability, and efficacy of distributing COVID-19 prevention kits to households with persons at increased risk of severe COVID-19 disease.
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Affiliation(s)
- Robert Colebunders
- Global Health Institute, University of Antwerp, Gouverneur Kinsbergen Centrum, Doornstraat 331, 2610 Antwerp, Belgium.
| | - Joseph Nelson Siewe Fodjo
- Global Health Institute, University of Antwerp, Gouverneur Kinsbergen Centrum, Doornstraat 331, 2610 Antwerp, Belgium.
| | - Guido Vanham
- Department of Biomedical Science, University of Antwerp, Campus drie Eiken, 2610 Antwerp, Belgium.
| | - Rafael Van den Bergh
- Global Health Institute, University of Antwerp, Gouverneur Kinsbergen Centrum, Doornstraat 331, 2610 Antwerp, Belgium.
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15
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Maarman GJ. A philosophical perspective on pulmonary hypertension: What is ‘rare’? S AFR J SCI 2020. [DOI: 10.17159/sajs.2020/7939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Gerald J. Maarman
- CARMA: Centre for Cardio-Metabolic Research in Africa, Tygerberg Medical School, Stellenbosch University, Cape Town, South Africa
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16
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Butrous G. Pulmonary hypertension: From an orphan disease to a global epidemic. Glob Cardiol Sci Pract 2020; 2020:e202005. [PMID: 33150150 PMCID: PMC7590934 DOI: 10.21542/gcsp.2020.5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 05/11/2020] [Indexed: 01/01/2023] Open
Abstract
[No abstract. Showing first paragraph of article]Pulmonary hypertension is a progressive disease characterized by an elevation of pulmonary artery pressure and pulmonary vascular resistance, leading to right ventricular failure and death. It remains a challenging chronic progressive disease, but the current interest and advent of medical therapy in the last 20 years has significantly changed the perception of medical community in this disease. Pulmonary hypertension is not a specific disease; the majority of cases present with other diseases and various pathological processes that affect the pulmonary vasculature, and consequently increase pulmonary pressure and vascular resistance.
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Affiliation(s)
- Ghazwan Butrous
- Medway School of Pharmacy University of Kent at Canterbury, UK
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17
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Mocumbi A, Mastala A, Guambe P, Dzudie A. Pulmonary vascular disease in Africa: Lessons from registries. Glob Cardiol Sci Pract 2020; 2020:e202002. [PMID: 33150147 PMCID: PMC7590930 DOI: 10.21542/gcsp.2020.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The epidemiology of pulmonary vascular disease (PVD) remains unclear in Africa, where health systems do not reach the majority of the population and heath information systems are poorly developed. In this context, registries are particularly important in gathering crucial information on PVD, aiming at improving knowledge of the epidemiology and/or quality of care. While population-based registries are the main tool to identify incident cases, and be a better indicator of pulmonary vascular disease burden, hospital-based registries can give an indication of the demand for specific care services, which is useful for health policy and planning. The only registry for pulmonary hypertension in Africa - the Pan African Pulmonary Hypertension Cohort (PAPUCO) - involved four countries, and was a pragmatic study that revealed a unique pattern of environmental risks, issues related to low access to health care, and ill-equipped health facilities for diagnosis and management of pulmonary hypertension. In addition, disease specific registries for conditions such as congenital heart disease and rheumatic heart disease uncovered high occurrence of PVD that can be managed and/or prevented with improvements in community awareness, surveillance, management and prevention. It is suggested that existing networks of experts and researchers develop regional registries to determine the epidemiology of PVD in Africa, assess geographic, environmental and seasonal differentials, as well as inform policy and care provision in the continent.
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Affiliation(s)
- Ana Mocumbi
- Instituto Nacional de Saúde, Marracuene, Mozambique.,Universidade Eduardo Mondlane, Maputo, Mozambique
| | | | - Phath Guambe
- Instituto Nacional de Saúde, Marracuene, Mozambique
| | - Anastase Dzudie
- Faculty of Medicine, University of Yaoundé, Yaounde, Cameroon.,Douala General Hospital, Douala, Cameroon.,Clinical Research Education, Networking and Consultancy, Douala, Cameroon
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18
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Dzudie A, Dzekem BS, Ojji DB, Kengne AP, Mocumbi AO, Sliwa K, Thienemann F. Pulmonary hypertension in low- and middle-income countries with focus on sub-Saharan Africa. Cardiovasc Diagn Ther 2020; 10:316-324. [PMID: 32420114 DOI: 10.21037/cdt.2019.07.06] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Pulmonary hypertension (PH) is a devastating, progressive disease with increasingly debilitating symptoms and usually shortened overall life expectancy. This article reviews the global epidemiology of PH with focus on low- and middle-income countries (LMICs) and sub-Sahara African in particular. Although left ventricular heart disease is the most common cause globally, the main contributing risk factors in LMICs are chronic infectious diseases especially human immunodeficiency virus (HIV) and schistosomiasis. Other important risk factors of PH are rheumatic heart disease, untreated congenital heart disease (CHD), and sickle cell disease. Despite existing epidemiological data of PH risk factors suggesting a high prevalence in sub-Saharan Africa (SSA), the available literature is limited. International registries in LMICs like the pan African pulmonary hypertension cohort (PAPUCO) study are essential to provide information about the causes, treatment, outcome, and the natural course of PH in Africa and other parts of the world. In addition, there is a need to track diagnostic and management practices in order to develop suitable algorithms to diagnose PH in LMICs.
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Affiliation(s)
- Anastase Dzudie
- Departments of Internal Medicine and Physiology, Faculty of Medicine, University of Yaoundé, Yaoundé, Cameroon.,Departments of Internal Medicine and Cardiology, Douala General Hospital, Douala, Cameroon.,Clinical Research Education, Networking and Consultancy, Douala, Cameroon
| | | | - Dike B Ojji
- Department of Medicine, Faculty of Clinical Sciences, University of Abuja, and University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Andre Pascal Kengne
- Non Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Ana Olga Mocumbi
- Instituto Nacional de Saúde, Maputo, Mozambique.,Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Friedrich Thienemann
- Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Internal Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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19
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Making a case for metallothioneins conferring cardioprotection in pulmonary hypertension. Med Hypotheses 2020; 137:109572. [DOI: 10.1016/j.mehy.2020.109572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/30/2019] [Accepted: 01/15/2020] [Indexed: 11/23/2022]
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20
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Rafikova O, James J, Eccles CA, Kurdyukov S, Niihori M, Varghese MV, Rafikov R. Early progression of pulmonary hypertension in the monocrotaline model in males is associated with increased lung permeability. Biol Sex Differ 2020; 11:11. [PMID: 32188512 PMCID: PMC7079376 DOI: 10.1186/s13293-020-00289-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 03/10/2020] [Indexed: 02/06/2023] Open
Abstract
Background The mechanisms involved in pulmonary hypertension (PH) development in patients and pre-clinical models are poorly understood. PH has a well-established sex dimorphism in patients with increased frequency of PH in females, and more severe disease with poor survival prognosis in males. Previously, we found that heme signaling plays an essential role in the development phase of the Sugen/Hypoxia (SU/Hx) model. This study is focused on the elucidation of sex differences in mechanisms of PH development related to heme action at the early stage of the monocrotaline (MCT) PH model. Methods Rats received MCT injection (60 mg/kg, i.p.) and followed for 14 days to investigate early disease changes. Hemodynamic parameters were recorded at the end of the study; plasma, lung homogenates, and nuclear fractions were used for the evaluation of protein levels. Results Our data indicate that on day 14, rats did not show any significant increase in the Fulton index due to the early disease phase. However, the right ventricular systolic pressure was significantly increased in male rats, while female rats showed only a trend. Interestingly, only males demonstrated an increased lung-to-bodyweight ratio that indicated lung edema. Indeed, lung histology confirmed severe perivascular edema in males. Previously, we have reported that the increased perivascular edema in SU/Hx model correlated with intravascular hemolysis and activated heme signaling. Here, we found that elevated free hemoglobin levels and perivascular edema were increased, specifically in males showing more rapid progress of PH. A high level of heme carrier protein 1 (HCP-1), which is involved in heme uptake from the bloodstream into the cells, was also found elevated in the lungs of males. The upregulation of heme oxygenase in males indicated increased intracellular heme catabolism. Increased heme signaling resulted in the activation of heme-mediated barrier-disruptive mechanisms. Thus, hemolysis in males can be responsible for increased permeability of the lungs and early disease development. Conclusions Our study indicates the importance of barrier-disruptive mechanisms as an earlier event in the induction of pulmonary hypertension. Importantly, males are more susceptible to hemolysis and develop PH earlier than females.
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Affiliation(s)
- Olga Rafikova
- Division of Endocrinology, Department of Medicine, University of Arizona, Tucson, AZ, 85721, USA
| | - Joel James
- Division of Endocrinology, Department of Medicine, University of Arizona, Tucson, AZ, 85721, USA
| | - Cody A Eccles
- Division of Endocrinology, Department of Medicine, University of Arizona, Tucson, AZ, 85721, USA
| | - Sergey Kurdyukov
- Division of Endocrinology, Department of Medicine, University of Arizona, Tucson, AZ, 85721, USA
| | - Maki Niihori
- Division of Endocrinology, Department of Medicine, University of Arizona, Tucson, AZ, 85721, USA
| | | | - Ruslan Rafikov
- Division of Endocrinology, Department of Medicine, University of Arizona, Tucson, AZ, 85721, USA.
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21
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Ouethy Nana Nguessie M, Mbaye F, Koudessi C, Fafa Cisse M, Nguessie Noumbou I, Thiam Thiam K, Dia Kane Y, Toure Badiane N. Hypertension pulmonaire au cours des connectivites : à propos de 12 cas. Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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22
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Bigna JJ, Um LN, Asangbeh SL, Sibetcheu AT, Kazé AD, Nansseu JR. Prevalence and incidence of major depressive disorders among people living with HIV residing in Africa: a systematic review and meta-analysis protocol. Syst Rev 2018; 7:6. [PMID: 29329579 PMCID: PMC5767019 DOI: 10.1186/s13643-018-0672-2] [Citation(s) in RCA: 3] [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: 07/18/2017] [Accepted: 01/03/2018] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Depression represents one of the most frequent neuro-psychiatric diseases; it seems to be more prevalent in people living with HIV compared to the general population. However, summarized data in the African setting on the topic are scarce. This systematic review and meta-analysis aims at assessing the prevalence and incidence of major depressive disorders (MDD) in HIV-infected African populations residing in Africa. METHODS AND DESIGN This review will include observational studies conducted among HIV-infected people residing in Africa, which have reported either the prevalence or incidence of MDD or enough data for its appraisal. Relevant records will be searched using PubMed/Medline, EMBASE, African Journals Online, and Africa Index Medicus. In addition, reference lists of eligible papers and relevant review articles will be screened. Published studies from inception Jan 1, 2000 to Dec 31, 2017 will be considered regardless of language of publication. Two review authors will independently screen, select studies, and extract data, with discrepancies resolved by consensus or arbitration by a third review author. Methodological quality of included studies will be assessed using the scale developed by Hoy and colleagues. Funnel-plots and Egger's test will be used to determine publication bias. The study-specific estimates will be pooled through a random-effects meta-analysis model to obtain an overall summary estimate. The heterogeneity will be evaluated by the χ2 test on Cochrane's Q statistic. Results will be presented by geographical region and antiretroviral therapy status. DISCUSSION This study is based on published data; therefore, ethical approval is not a requirement. The final report of this study in the form of a scientific paper will be published in a peer-reviewed journal and presented at scientific conferences. This review will help to have an overview of the burden of MDD among HIV-infected people residing in Africa. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42017058118 .
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Affiliation(s)
- Jean Joel Bigna
- Department of Epidemiology and Public Health, Centre Pasteur of Cameroon, PO Box: 1274, Yaoundé, Cameroon. .,School of Public Health, Faculty of Medicine, University of Paris Sud XI, Le Kremlin-Bicêtre, France.
| | - Lewis N Um
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Serra Lem Asangbeh
- Agence Nationale de Recherche sur le Sida et les hépatites virales, Yaoundé, Cameroon
| | - Aurelie T Sibetcheu
- Department of Pediatrics, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Arnaud D Kazé
- Division of Renal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jobert Richie Nansseu
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon.,Department of Disease, Epidemics and Pandemics Control, Ministry of Public Health, Yaoundé, Cameroon
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