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Belete AM, Melese DM, Bewket B, Tegegne B, Shiferaw WS, Aynalem YA, Asefa A, Yazie TS. Dyslipidemia among adult HIV patients on antiretroviral therapy and its association with age and body mass index in Ethiopia: A systematic review and meta-analysis. PLoS One 2024; 19:e0298525. [PMID: 38722964 PMCID: PMC11081291 DOI: 10.1371/journal.pone.0298525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/26/2024] [Indexed: 05/13/2024] Open
Abstract
INTRODUCTION Dyslipidemia is a common public health problem in people living with human immunodeficiency virus (HIV) who are receiving antiretroviral therapy and increases the risk of cardiovascular disease. Although evidence indicates that the prevalence of dyslipidemia is high, estimated pooled data are not well documented. Therefore, we aimed to estimate the pooled prevalence of dyslipidemia in adult people living with HIV receiving antiretroviral therapy in Ethiopia. METHOD We conducted a systematic review and meta-analysis of the literature. The following databases and grey literature were searched: PubMed, WorldCat, ScienceDirect, DOAG, African Journals Online, Google Scholar, and African Index Medicine. We included all comparative epidemiological studies that reported the prevalence of high concentration of total cholesterol, triglycerides, and low density lipoprotein, and low concentration of high density lipoprotein cholesterol that were published between January 2003 and July 2023. The random effects model was used to pool the outcome of interest. Additionally, subgrouping, sensitivity analyses, and funnel plots were performed. R software Version 4.2.1 was used for statistical analysis. RESULT Seventeen studies with a total of 3929 participants were included in the meta-analysis. The pooled prevalence of dyslipidemia, high total cholesterol, high triglyceride, elevated level of low density lipoprotein and low level of high density lipoprotein cholesterol were 69.32% (95% CI: 63.33, 74.72), 39.78% (95%CI: 32.12, 47.96), 40.32% (95%CI: 34.56, 46.36), 28.58% (95%CI: 21.81, 36.46), and 36.17% (95%CI: 28.82, 44.24), respectively. Age and body mass index were associated with high total cholesterol, triglyceride, and low-density lipoprotein cholesterol levels. CONCLUSION The authors concluded that the prevalence of dyslipidemia in Ethiopia is high in people living with HIV receiving antiretroviral therapy. Early detection of dyslipidemia and its integration into treatment are essential for preventing cardiovascular disease. TRIAL REGISTRATION Protocol registered with PROSPERO (CRD42023440125).
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Affiliation(s)
- Abebe Muche Belete
- Department of Biomedical Science, Asrat Weldyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Daniel Molla Melese
- Department of Biomedical Science, Asrat Weldyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Bekalu Bewket
- Department of Nursing, College of Health Science, Injibara University, Injibara, Ethiopia
| | - Belachew Tegegne
- Department of Nursing, College of Health Science, Injibara University, Injibara, Ethiopia
| | - Wondimeneh Shibabaw Shiferaw
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Australia
- Department of Nursing, Asrat Weldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | | | - Adisu Asefa
- Department of Non communicable disease, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Taklo Simeneh Yazie
- Department of Pharmacy, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
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Singhato A, Booranasuksakul U, Khongkhon S, Rueangsri N. Effectiveness of the Therapeutic Lifestyle Change Diet Intervention to Improve Biochemical Markers of Cardiovascular Diseases in HIV-Infected Patients with Dyslipidemia. ANNALS OF NUTRITION & METABOLISM 2024; 80:202-210. [PMID: 38631311 DOI: 10.1159/000538578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/20/2024] [Indexed: 04/19/2024]
Abstract
INTRODUCTION This randomized controlled trial study aimed to investigate the effectiveness of therapeutic lifestyle change (TLC) diet intervention by the registered dietitians. METHODS Eighty-two people living with HIV (PLHIV) with dyslipidemia were randomly allocated to the intervention group as well as another 82 PLHIV with dyslipidemia to the control group. Participants in the intervention group were instructed to meet the registered dietitians every 2 weeks at weeks 0, 2, 4, 6, and 12 (a totally of 12 weeks) to receive individual medical nutrition therapy according to the TLC diet principles, while the participants in the control group only received routine health care service. RESULTS Triglycerides, total cholesterol, and LDL cholesterol of the intervention group were significantly lower than those of the control group at the endpoint (p < 0.05). In addition, these biomarkers and C-reactive protein of the intervention group were significantly lower when compared with their baseline (p < 0.05). The overall dietary habits of participants in the intervention group were significantly improved at the end of the study (p < 0.05). CONCLUSION The medical nutrition therapy intervention based on the TLC diet is effective in improving blood lipid profiles among PLHIV with dyslipidemia.
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Affiliation(s)
- Alongkote Singhato
- Nutrition and Dietetics Division, Faculty of Allied Health Sciences, Burapha University, Chonburi, Thailand
| | - Uraiporn Booranasuksakul
- Nutrition and Dietetics Division, Faculty of Allied Health Sciences, Burapha University, Chonburi, Thailand
| | - Somjet Khongkhon
- Thai Traditional Medicine Division, Faculty of Thai Traditional and Alternative Medicine, Ubon Ratchathani Rajabhat University, Ubon Ratchathani, Thailand
| | - Narisa Rueangsri
- Nutrition and Dietetics Division, Faculty of Allied Health Sciences, Burapha University, Chonburi, Thailand
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Kigongo VJ, Nankabirwa JI, Kitutu FE, Ssenyonga R, Mutebi RK, Kazibwe A, Kiguba R, Kambugu AD, Castelnuovo B. Dyslipidemia among adult people living with HIV on dolutegravir - based antiretroviral therapy at a private tertiary hospital in Kampala, Uganda: burden and determinants. BMC Infect Dis 2024; 24:53. [PMID: 38183002 PMCID: PMC10770888 DOI: 10.1186/s12879-023-08892-8] [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: 12/11/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Understanding the burden of dyslipidemia and its associated factors among adult people living with HIV on dolutegravir (DTG) based anti-retroviral therapy (ART) is critical to provide clinical guidance and risk reduction strategies in our setting. METHODS We conducted a cross-sectional study on adult people living with HIV on DTG based ART between July and August 2022 at Mengo Hospital, a private not for profit missionary hospital owned by the Church of Uganda. Dyslipidemia was defined as: Total cholesterol (TC) ≥ 5.2 mmol/l, or high-density lipoprotein (HDL) < 1 mmol/l for men and < 1.3 mmol/l for women, or triglycerides (TG) ≥ 1.7 mmol/l, and low-density lipoprotein (LDL) ≥ 3.4 mmol/l. A participant was considered to have dyslipidemia if they had any of the lipid profile parameters in the above ranges. Socio-demographic information, clinical data and behavioral characteristics were collected. Fasting lipid profile and fasting blood glucose levels were also measured. Bivariate and multivariate analyses were done using a generalized linear model regression of the Poisson family with a log link (modified Poisson) using robust standard errors since the prevalence of dyslipidemia was more than 10%. Adjusted prevalence ratios (PR) were reported with their 95% confidence intervals (CI). A p-value of less than 0.05 was considered statistically significant. RESULTS A total of 341 participants were included. The prevalence of dyslipidemia was 78.0%, (95%CI:73.3-82.1). The highest prevalence was for low HDL (72.1%, 95%CI 67.1-76.7) followed by high TG (20.2%, 95%CI: 16.3-24.9), high TC (12.0%, 95%CI: 9.0-15.9) and high LDL (6.5%, 95%CI: 4.3-9.6). Female sex (aPR:1.55, 95%CI: 1.32-1.84, p < 0.001) and previous use of protease inhibitor (PI) based ART regimen (aPR:1.26, 95%CI: 1.04-1.53, p = 0.018) were significantly associated with dyslipidemia. CONCLUSION We demonstrate that the prevalence of dyslipidemia is very high as it was present in more than three quarters of the study participants. Female sex and previous use of PI based ART regimen were significantly associated with dyslipidemia. Management of dyslipidemia should be integrated in the HIV treatment package and we recommend further inquiry into the temporal relationship between dyslipidemia and DTG among ART patients, if any.
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Affiliation(s)
- Vianney John Kigongo
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
- The AIDS Support Organisation (TASO), Kampala, Uganda.
| | - Joaniter I Nankabirwa
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Freddy Eric Kitutu
- Department of Pharmacy, Makerere University School of Health Sciences, Kampala, Uganda
| | - Ronald Ssenyonga
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | | | | | - Ronald Kiguba
- Department of Pharmacology and Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda
| | - Andrew D Kambugu
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
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Mohammed O, Alemayehu E, Debash H, Belete MA, Gedefie A, Tilahun M, Ebrahim H, Gebretsadik Weldehanna D. Dyslipidemia among HIV-infected patients in Ethiopia: a systematic review and meta-analysis. BMC Infect Dis 2024; 24:27. [PMID: 38166636 PMCID: PMC10763320 DOI: 10.1186/s12879-023-08910-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Dyslipidemia is responsible for more than half of the global ischemic heart disease (IHD) and more than 4 million deaths annually. Assessing the prevalence of dyslipidemia can be crucial in predicting the future disease development and possible intervention strategies. Therefore, this systematic review and meta-analysis was aimed at assessing the pooled prevalence of dyslipidemia in HIV-infected patients. METHODS Electronic databases such as EMBASE, Google Scholar, PubMed, Web of Science, ResearchGate, Cochrane Library, and Science Direct were searched for articles and grey literature. All relevant studies found until our search period of May 24, 2023 were included. The Newcastle-Ottawa Quality Assessment Scale was used to assess the quality of the included studies. The data were extracted in Microsoft Excel. The STATA version 14 software was used to conduct the meta-analysis. I2 and Cochran's Q test were employed to assess the presence of heterogeneity between studies. Due to the presence of heterogeneity, a random effect model was used. The publication bias was assessed using the symmetry of the funnel plot and Egger's test statistics. Moreover, subgroup analysis, and sensitivity analysis were also done. RESULTS A total of nine studies that reported the prevalence of dyslipidemia were included. The overall pooled prevalence of dyslipidemia among HIV-infected patients in Ethiopia was 67.32% (95% CI = 61.68%-72.96%). Furthermore, the overall pooled estimates of dyslipidemia among ART-taking and treatment-naïve HIV-infected patients were 69.74% (95% CI: 63.68-75.8, I2 = 87.2) and 61.46% (95% CI: 45.40-77.52, I2 = 90.3), respectively. Based on lipid profile fractionations, the pooled estimates for high total cholesterol (TC) were 39.08% (95% CI: 31.16-46.99), high triglycerides were 38.73% (95% CI: 28.58-48.88), high low density lipoprotein (LDL-c) was 28.40% (95% CI: 17.24-39.56), and low high density lipoprotein (HDL-c) was 39.42% (95% CI: 30.47-48.38). CONCLUSION More than two-thirds of HIV-infected patients experienced dyslipidemia. Therefore, it's critical to regularly evaluate lipid alterations in HIV-infected patients in order to prevent the onset of atherosclerosis and other cardiovascular problems.
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Affiliation(s)
- Ousman Mohammed
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
| | - Ermiyas Alemayehu
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Habtu Debash
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Melaku Ashagrie Belete
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Alemu Gedefie
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Mihret Tilahun
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Hussen Ebrahim
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Daniel Gebretsadik Weldehanna
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Amutuhaire W, Mulindwa F, Castelnuovo B, Brusselaers N, Schwarz JM, Edrisa M, Dujanga S, Salata RA, Yendewa GA. Prevalence of Cardiometabolic Disease Risk Factors in People With HIV Initiating Antiretroviral Therapy at a High-Volume HIV Clinic in Kampala, Uganda. Open Forum Infect Dis 2023; 10:ofad241. [PMID: 37351455 PMCID: PMC10284103 DOI: 10.1093/ofid/ofad241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/27/2023] [Indexed: 06/24/2023] Open
Abstract
Background Cardiometabolic diseases are a leading cause of HIV-related morbidity and mortality, yet routine screening is not undertaken in high-burden countries. We aimed to assess the prevalence and risk factors of the metabolic syndrome (MetS) and its components in adult Ugandan people with HIV (PWH) initiating dolutegravir-based antiretroviral therapy (ART). Methods We conducted a cross-sectional study using baseline sociodemographic and clinical data of PWH aged ≥18 years enrolled in the Glucose metabolism changes in Ugandan HIV patients on Dolutegravir (GLUMED) study from January to October 2021. MetS was defined as having ≥3 of the following: abdominal obesity, hypertension (HTN), hyperglycemia, elevated triglycerides, and low high-density lipoprotein cholesterol. Multiple logistic regression was used to assess associations between potential risk factors and MetS and its components. Results Three hundred nine PWH were analyzed (100% ART-naïve, 59.2% female, median age 31 years, and median CD4 count 318 cells/mm3). The prevalence of MetS was 13.9%. The most common cardiometabolic condition was dyslipidemia (93.6%), followed by abdominal obesity (34.0%), hyperglycemia (18.4%), and HTN (8.1%). In adjusted analysis, MetS was associated with age >40 years (adjusted odds ratio [aOR], 3.33; 95% CI, 1.45-7.67) and CD4 count >200 cells/mm3 (aOR, 3.79; 95% CI, 1.23-11.63). HTN was associated with age >40 years (aOR, 2.96; 95% CI, 1.32-6.64), and dyslipidemia was associated with urban residence (aOR, 4.99; 95% CI, 1.35-18.53). Conclusions Cardiometabolic risk factors were common in this young Ugandan cohort of PWH initiating dolutegravir-based ART, underscoring the need for programmatic implementation of surveillance and management of comorbidities in Uganda and similar settings.
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Affiliation(s)
- Willington Amutuhaire
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Frank Mulindwa
- Makerere University Infectious Diseases Institute, Kampala, Uganda
- Global Health Institute, Antwerp University, Antwerp, Belgium
| | | | - Nele Brusselaers
- Global Health Institute, Antwerp University, Antwerp, Belgium
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Jean-Marc Schwarz
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Mutebi Edrisa
- Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Robert A Salata
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - George A Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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Mohammed O, Alemayehu E, Ebrahim E, Fiseha M, Gedefie A, Ali A, Ebrahim H, Tilahun M. Atherogenic dyslipidemia and associated risk factors among hypertensive patients of five health facilities in Northeast Ethiopia. PLoS One 2023; 18:e0277185. [PMID: 36787318 PMCID: PMC9928121 DOI: 10.1371/journal.pone.0277185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 10/21/2022] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND One of the major risk factors for cardiovascular disease is atherogenic dyslipidemia. There was, however, little information available in Ethiopia. Therefore, the purpose of this study was to estimate the prevalence of atherogenic dyslipidemia and related risk factors in Northeast Ethiopian hypertension patients. MATERIALS AND METHODS A systematic random sampling technique was used to perform a cross-sectional study at an institution with 384 chosen participants. A structured questionnaire was used to collect the socio-demographic, anthropometric, lifestyle, and clinical characteristics of the respondents. Student's t-test, Mann-Whitney test, and Pearson's Chi-square test were employed to compare groups based on the type of data. Furthermore, Bivariate and multivariable logistic regression analyses were performed to identify factors independently associated with dyslipidemia. Crude and adjusted odds ratios and their corresponding 95% Confidence Intervals (CI) were computed. In all cases, statistical significance was declared at p <0.05. RESULTS The majority (93.2%; 95%CI: 90.6-95.6) of patients had at least one atherogenic dyslipidemia. The prevalence of elevated total cholesterol (TC), elevated triglyceride (TG), raised low-density lipoprotein cholesterol (LDL-c), and reduced high-density lipoprotein cholesterol (HDL-c) were 47.7%, 50.3%, 44.3%, and 59.6%, respectively. Being≥ 40 years were at higher risk for having elevated levels of TC (AOR: 3.22, 95% CI: 2.40-4.32), TG (AOR: 2.30, 95% CI: 1.61-3.79), and LDL-c (AOR: 4.68, 95% CI: 2.0-10.95) than those who were below 40years. Obese participants were more likely to have high concentrations of TC (AOR: 2.57, 95%CI: 2.10-3.22), LDL-c (AOR: 3.13, 95% CI: 1.97-5.10), HDL-c (AOR: 2.71, 95% CI: 1.77-4.58), and TG (AOR: 2.23, 95%CI: 1.79-4.16). CONCLUSION This study revealed that a high prevalence of atherogenic dyslipidemia. Thus, to prevent atherogenic dyslipidemia, it is crucial to create routine blood lipid testing programs and carry out suitable intervention programs focused on risk factor reduction.
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Affiliation(s)
- Ousman Mohammed
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
- * E-mail:
| | - Ermiyas Alemayehu
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Endris Ebrahim
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Mesfin Fiseha
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Alemu Gedefie
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Abdurrahman Ali
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Hussen Ebrahim
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Mihret Tilahun
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Obsa MS, Ataro G, Awoke N, Jemal B, Tilahun T, Ayalew N, Woldegeorgis BZ, Azeze GA, Haji Y. Determinants of Dyslipidemia in Africa: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2022; 8:778891. [PMID: 35284497 PMCID: PMC8904727 DOI: 10.3389/fcvm.2021.778891] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 12/29/2021] [Indexed: 12/18/2022] Open
Abstract
Background Dyslipidemia is a common public health problem in Africa. It has emerged as an important cardiovascular risk factor. It has been steadily increasing due to economic growth, urbanization, and unhealthy dietary pattern. Therefore, it is essential to identify determinants of dyslipidemia to prevent the condition and reduce its long-term sequel. Methods Combinations of search terms with Boolean operators were used to retrieve studies from PubMed, EMBASE, Cochrane Database, Cinahl, Scopus, Mednar, and Google Scholar. The methodological quality of each article was evaluated based on the 2017 Joanna Briggs Institute (JBI) Critical Appraisal checklist for prevalence studies. After evaluation of each study against these criteria, studies with a minimum score of 7 or above out of 9 JBI checklists were included. We included articles presented in the English language. The Cochrane Q test was used to assess the heterogeneity across studies. The visual assessment of publication bias was done by creating a funnel plot. The possible causes of heterogeneity were explored by subgroup analyses. Egger's weighted regression test was used to assess the presence of publication bias. Statistical analyses were done by using the STATA software version 14. Result A total of 24 articles involving 37,902 participants from 10 African countries were included. The overall pooled prevalence of dyslipidemia was 52.8 (95% CI 40.8–64.9). Individuals with a body mass index (BMI) >25.0 kg/m2 and waist circumference (WC) >94 cm were, respectively, 2.36 (95% CI (1.33–4.18), p < 0.001) and 2.33 (95% CI (0.75–0.29) p < 0.001) times more likely to develop dyslipidemia than those with lower values. Furthermore, patients with diabetes mellitus (DM) and hypertension (HTN) were 2.32 (95% CI (0.89–6.05) p < 0.001) and 2.05 (95% CI (1.31–3.21), p < 0.001) times more likely to present with dyslipidemia than non-diabetic patients and those without HTN. Conclusion This study revealed that the prevalence of dyslipidemia is relatively high among study participants in African countries and the independent predictors of dyslipidemia were BMI >25.0 kg/m2, WC > 94 cm, raised blood glucose level, and raised blood pressure. Therefore, there should be a pressing public health measure to prevent, identify, and treat dyslipidemia with the special emphasis on obese, diabetic, and hypertensive patients.
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Affiliation(s)
- Mohammed S Obsa
- College of Health Science and Medicine, Wolaita Soddo University, Wolaita Soddo, Ethiopia
| | - Getu Ataro
- College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
| | - Nefsu Awoke
- College of Health Science and Medicine, Wolaita Soddo University, Wolaita Soddo, Ethiopia
| | - Bedru Jemal
- College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Tamiru Tilahun
- College of Health Science and Medicine, Wolaita Soddo University, Wolaita Soddo, Ethiopia
| | - Nugusu Ayalew
- Department of Anesthesia, Kotebe Metropolitan University, Addis Ababa, Ethiopia
| | - Beshada Z Woldegeorgis
- College of Health Science and Medicine, Wolaita Soddo University, Wolaita Soddo, Ethiopia
| | - Gedion A Azeze
- College of Health Science and Medicine, Wolaita Soddo University, Wolaita Soddo, Ethiopia
| | - Yusuf Haji
- College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
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Kifle ZD, Alehegn AA, Adugna M, Bayleyegn B. Prevalence and predictors of dyslipidemia among hypertensive patients in Lumame Primary Hospital, Amhara, Ethiopia: A cross-sectional study. Metabol Open 2021; 11:100108. [PMID: 34355158 PMCID: PMC8319795 DOI: 10.1016/j.metop.2021.100108] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 07/12/2021] [Accepted: 07/12/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Serum lipid profile abnormalities are major predictors for coronary artery diseases. The relationship between demographic factors and dyslipidemia in Ethiopia is not completely explored. Thus, this study aimed to assess the prevalence and predictors of dyslipidemia among hypertensive patients in Lumame Primary Hospital. METHODS A cross-sectional study was conducted from June to August 30, 2020, on the hypertensive patients in Lumame Primary Hospital. All adult hypertensive patients who visited the adult hypertensive care services during the study period were included. Interview-guided self-administered questionnaire and a chart review were used for data collection. Statistical Package for the Social Sciences (SPSS) software version 24.0 was used for data analysis. RESULTS Out of 372 hypertensive patients, 190(51.1%) were females and the mean age of the study participants was 43.56 years (SD ± 4.31). The overall prevalence of dyslipidemia in this study was 48.4%. Besides the overall prevalence, the prevalence of TC, TG, LDL-c, and HDL-c was 73(19.6%), 91(24.5%), 60(16.1%), and 115(30.9%), respectively. Females were at higher risk for having high levels of TC (AOR = 2.31, 95% CI = 1.54-3.13), TG (AOR = 1.70, 95% CI = 1.34-3.79), LDL-c (AOR = 2.15, 95% CI = 1.56-2.86), and HDL-c (AOR = 2.67, 95% CI = 1.44-5.67) than males. Respondents who were from urban were at higher risk for having high levels of TC (AOR = 1.98, 95% CI = 1.04-6.83), TG (AOR = 1.78, 95% CI = 1.09-2.86), LDL-c (AOR = 3.01, 95% CI = 1.45-7.43), and HDL-c (AOR = 2.01, 95% CI = 1.94-4.55) than respondents who were from rural. Similarly, obese respondents were at higher risk for having high levels of TC (AOR = 2.03, 95% CI = 1.64-2.00), TG (AOR = 3.78, 95% CI = 1.06-6.42), LDL-c (AOR = 1.92, 95% CI = 1.66-2.12), and HDL-c (AOR = 4.23, 95% CI = 2.84-4.32) than to respondents who were underweight. CONCLUSION The prevalence of dyslipidemia among hypertensive patients was high. Independent variables such as age, gender, residence, family history of HTN, smoking, alcohol drinking, fruit diet habits, physical activity, DM, and BMI were significant determinants of dyslipidemia.
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Affiliation(s)
- Zemene Demelash Kifle
- Department of Pharmacology, School of Pharmacy, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | | | - Meaza Adugna
- Department of Pharmacology, School of Pharmacy, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Biruk Bayleyegn
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Prevalence of dyslipidaemia among HIV-infected patients receiving combination antiretroviral therapy in North Shewa, Ethiopia. PLoS One 2021; 16:e0250328. [PMID: 33905435 PMCID: PMC8078799 DOI: 10.1371/journal.pone.0250328] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 04/05/2021] [Indexed: 11/19/2022] Open
Abstract
Background Data on the burden of dyslipidaemia among people with HIV undergoing antiretroviral therapy (ART) in sub-Saharan Africa are limited and little is known about the factors contributing for poor lipid profiles. The aim of this study was to determine the prevalence of dyslipidaemia and factors associated with lipid levels among HIV-infected patients receiving first-line combination ART in North Shewa, Ethiopia. Methods A cross-sectional study was conducted between April and December 2018 among 392 HIV-infected adults receiving first-line ART for at least six months at the ART clinic of Mehal Meda Hospital in North Shewa, Ethiopia. Blood samples were collected for determination of total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), and CD4 counts. Logistic regression analysis was used to determine factors associated with lipid abnormalities. Results The prevalence of dyslipidaemia was 59.9% (95% CI 55.0–64.7%). High TC, high TG, low HDL-c, and high LDL-c were obtained in 47.3%, 30.9%, 19.4% and 29.6%, respectively. Fifty-four participants (13.8%) had high ratio of TC/HDL-c (TC/HDL-c ratio ≥ 5). Older age was independently associated with high TC (AOR = 2.51, 95% CI 1.64–3.84), high TG (AOR = 2.95, 95% CI 1.85–4.71), low HDL–c (AOR = 2.02, 95% CI 1.17–3.50), and high LDL–c (AOR = 3.37, 95% CI 2.08–5.47). Living in an urban area (AOR = 2.61, 95% CI 1.16–6.14) and smoking (AOR = 3.61, 95% CI 1.06–12.34) were associated with low HDL–c. Participants with longer duration of ART use were more likely to have high TG (AOR = 1.86, 95% CI: 1.13–3.07), low HDL–c (AOR = 3.47, 95% CI: 1.75–6.80), and high LDL–c (AOR = 2.20, 95% CI 1.30–3.71). High BMI was independently associated with higher TC (AOR = 2.43, 95% CI 1.19–4.97), high TG (AOR = 4.17, 95% CI 2.01–8.67) and high LDL–c (AOR = 6.53, 95% CI 3.05–13.98). Conclusions We found a high prevalence of dyslipidaemia among HIV-infected patients receiving first-line ART in North Shewa, Ethiopia. There is a need for monitoring of blood lipid levels in patients with HIV on long term first-line ART with a special attention to be focused on older age, urban residents, longer duration of ART use, high BMI and smokers.
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Hamooya BM, Musonda P, Mutale W, Masenga SK, Halwiindi H, Mutengo KH, Chiyeñu KOR, Chongwe G, Koethe JR, Lipworth L, Heimburger DC. Prevalence of low high-density lipoprotein among young adults receiving antiretroviral therapy in Zambia: An opportunity to consider non-communicable diseases in resource-limited settings. PLoS One 2021; 16:e0247004. [PMID: 33592027 PMCID: PMC7886128 DOI: 10.1371/journal.pone.0247004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 01/29/2021] [Indexed: 01/13/2023] Open
Abstract
Background With the introduction of effective antiretroviral therapy (ART), people living with HIV (PLWH) are surviving longer and are at risk for developing metabolic abnormalities that contribute to cardiovascular disease (CVD). In Sub-Saharan Africa (SSA), there is a paucity of epidemiological data on lipid profiles among young adults receiving ART. This study aimed to estimate the prevalence of low high-density lipoprotein cholesterol (HDL-c), a cardioprotective lipid class, and whether it differed by age among adults on ART in Livingstone, Zambia. Methods From April to December 2019, we conducted a cross-sectional study of 597 PLWH [n = 58 aged 18–24 years (young adults); n = 539 aged ≥25 years (adults)] on ART for ≥6 months. Data collected included demographic and lifestyle information, anthropometrics, viral load (VL), CD4 count, blood pressure, lipid profiles and fasting/random blood glucose. Clinical measures were defined as: low HDL-c [<1.0 mmol/L for men, <1.3 for women], increased waist circumference (WC) [≥94 cm for men, ≥80 cm for women], high triglycerides (TG) [≥1.7 mmol/l], and virological failure (VF) [VL ≥1000 copies/μl]. We used logistic regression to examine the association between age and low HDL-c after adjusting for multiple variables. Results Among the young adults, 60% (35/58) were women, median (25th, 75th percentile) age 21 years (18, 23), and median time on ART 116 months (60, 144). Among adults, 63% (342/539) were women, median age 46 years (40, 53) and median time on ART 108 months (60, 144). Young adults had a lower CD4 count compared to adults (median, 492 vs. 568 cells/μL, p = 0.010) and higher prevalence of VF (29% vs. 17%, p = 0.016). In young adults, prevalence of low HDL-c was significantly higher than in adults (63 vs. 38%, p<0.001). A high proportion of young adults (75%) and adults (58%) with low HDL-c were on dolutegravir (DTG)-based ART regimens. After adjusting for sex, duration on ART, WC, body mass index, ART regimen, VF, CD4 count, low density lipoprotein cholesterol, blood pressure and smoking, young adults were significantly more likely than adults to have low HDL-c (odds ratio 2.93; 95% confidence interval 1.46–5.86). Conclusion Low HDL-c is highly prevalent among young adult with HIV in SSA independent of other risk factors for metabolic derangements. Lipid abnormalities among young PLWH may contribute to the early development of cardiovascular diseases in this population. This highlights the need to consider low HDL-c in the quest to reduce CVD risk among young adults on ART in SSA.
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Affiliation(s)
- Benson M. Hamooya
- University of Zambia School of Public Health, Lusaka, Zambia
- Mulungushi University School of Medicine and Health Sciences, Livingstone, Zambia
- Vanderbilt Institute for Global Health, Nashville, TN, United States of America
- * E-mail:
| | - Patrick Musonda
- University of Zambia School of Public Health, Lusaka, Zambia
| | - Wilbroad Mutale
- University of Zambia School of Public Health, Lusaka, Zambia
| | - Sepiso K. Masenga
- Mulungushi University School of Medicine and Health Sciences, Livingstone, Zambia
- Department of Biomedical Sciences, University of Zambia School of Health Sciences, Lusaka, Zambia
- Vanderbilt University Medical Center, Nashville, TN, United States of America
| | | | - Katongo H. Mutengo
- Livingstone Central Hospital, Livingstone, Zambia
- Ministry of Health, Lusaka, Zambia
| | - Kaseya O. R. Chiyeñu
- Livingstone Central Hospital, Livingstone, Zambia
- Ministry of Health, Lusaka, Zambia
| | - Gershom Chongwe
- University of Zambia School of Public Health, Lusaka, Zambia
| | - John R. Koethe
- Vanderbilt Institute for Global Health, Nashville, TN, United States of America
- Vanderbilt University Medical Center, Nashville, TN, United States of America
- Vanderbilt University School of Medicine, Nashville, TN, United States of America
| | - Loren Lipworth
- Vanderbilt University Medical Center, Nashville, TN, United States of America
- Vanderbilt University School of Medicine, Nashville, TN, United States of America
| | - Douglas C. Heimburger
- Vanderbilt Institute for Global Health, Nashville, TN, United States of America
- Vanderbilt University Medical Center, Nashville, TN, United States of America
- Vanderbilt University School of Medicine, Nashville, TN, United States of America
- University of Zambia School of Medicine, Lusaka, Zambia
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Gebreegziabiher G, Belachew T, Mehari K, Tamiru D. Prevalence of dyslipidemia and associated risk factors among adult residents of Mekelle City, Northern Ethiopia. PLoS One 2021; 16:e0243103. [PMID: 33561153 PMCID: PMC7872241 DOI: 10.1371/journal.pone.0243103] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 11/13/2020] [Indexed: 12/19/2022] Open
Abstract
Introduction Dyslipidemia is a major risk factor for cardiovascular diseases (CVD). The prevalence of dyslipidemia is not known among Ethiopian adults. The prevalence is expected to rise due to the socio-economic development accompanied by lifestyle changes. This study was conducted to estimate the prevalence of dyslipidemia and associated risk factors among adult residents of Mekelle City. Methods A community-based cross-sectional study was conducted among 321 randomly selected subjects. Data were collected on sociodemographic, anthropometric, lifestyle, and clinical characteristics of the participants using the WHO STEPS survey instrument. Data were analyzed using SPSS software version 24.0. Student’s t-test and Pearson’s Chi-square test were used to assessing the interrelationship between each factor and outcome variables. Bivariate and multivariable logistic regression analysis were used to identify risk factors associated with dyslipidemia. All statistical significance was considered at p ≤0.05. Results The prevalence of dyslipidemia in this study was 66.7%. The prevalence of high low-density lipoprotein cholesterol (LDL-C), elevated triglyceride, elevated total cholesterol, and low high-density lipoprotein cholesterol (HDL-C) was 49.5%, 40.2%, 30.8%, and 16.5%, respectively. Being above 64 years (aOR: 2.196, 95% CI: 1.183–4.078) and 40–64 years old (aOR: 2.196, 95% CI: 1.183–4.078), overweight (aOR: 2.50, 95% CI: 1.314–4.756) and obesity (aOR: 15.489, 95% CI: 3.525–68.070), walking <150 minutes per week (aOR: 1.722, 95% CI: 1.004–2.953), raised fasting blood glucose (FBG) (aOR: 4.804, 95% CI: 1.925–11.988), and medium socio-economic status (aOR: 2.017, 95% CI: 1.044–3.899) were identified as significant predictors of dyslipidemia. Conclusions The finding of this study indicated that the prevalence of dyslipidemia is unacceptably high among adult residents of Mekelle City, which underlines an urgent need for early detection and public health interventions through the integrated involvement of public, governmental, and non-governmental organizations.
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Affiliation(s)
- Gebremedhin Gebreegziabiher
- Department of Human Nutrition, School of Public Health, College of Medicine and Health Sciences, Adigrat University, Adigrat, Tigray, Ethiopia
- * E-mail:
| | - Tefera Belachew
- Department of Nutrition and Dietetics, Faculty of Public Health, Jimma University, Jimma, Oromia, Ethiopia
| | - Kibrti Mehari
- Tigray Health Research Institute, Mekelle, Tigray, Ethiopia
| | - Dessalegn Tamiru
- Department of Nutrition and Dietetics, Faculty of Public Health, Jimma University, Jimma, Oromia, Ethiopia
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Muche Belete A, Seifu D, Menon M, Amogne W, Shewa A, Adela Tefera A. Serum Lipid Profiles of Patients Taking Efavirenz-Based Antiretroviral Regimen Compared to Ritonavir-Boosted Atazanavir with an Optimized Background at Zewditu Memorial Hospital, Addis Ababa, Ethiopia. HIV AIDS (Auckl) 2021; 13:217-227. [PMID: 33642881 PMCID: PMC7903961 DOI: 10.2147/hiv.s296170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/11/2021] [Indexed: 01/11/2023] Open
Abstract
Background Dyslipidemia represents significant health care concerns in patients taking antiretroviral therapy due to their association with cardiovascular disease risk. There is limited data regarding the effects of boosted atazanavir (ATV/r) treatment in the lipid profiles of Ethiopian HIV patients. Thus, this study compares the mean values of lipid profile differences of HIV patients on ATV/r-based regimen compared to efavirenz (EFV)-based regimen, while the background is Tenofovir Disoproxil Fumarate/lamivudine. Materials and Methods A comparative hospital-based cross-sectional study was conducted among adult HIV-infected patients at Zewditu Memorial Hospital, Addis Ababa, Ethiopia, from July–September 2017. An equal number of EFV and ATV/r-treated patients (n=90 each) receiving for 1-year and over were included in the study. Serum total cholesterol (TC), triglyceride (TG), gigh-density lipoprotein cholesterol (HDL-c), and low-density lipoprotein cholesterol (LDL-c) were measured. Data comparison used chi-square test, Student’s t-test and Mann–Whitney U-test. Multivariate logistic regression analysis and p-value<0.05 were used to identify associated factors of serum lipid profiles. Results In the present study, the ATV/r-treated group results were significantly higher in the median values of TG [207 (56–1094) vs 145 (42–768) mg/dL; p=0.001] and the mean value of TG/HDL-c (6.6 vs 4.4; p=0.001) as compared to the EFV-treated group. The EFV-treated group showed significantly higher in the mean value of HDL-c (44.7 vs 38.7 mg/dL; p=0.001) as compared to the ATV/r-treated group. Body mass index was associate with LDL and HDL. CD4 was associated with TC. Current antiretroviral therapy was associated with TG. Duration of HIV since first diagnosis and duration of ART were associated with HDL. Conclusion ATV/r is associated with elevated in TG and TG/HDL-C, but low HDL as compared to EFV. Differences in LDL or HDL that were found were of unclear clinical significance. The long-term significance is unknown.
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Affiliation(s)
- Abebe Muche Belete
- Department of Biochemistry, Medical Faculty, Debre Berhan University, Debre Berhan, Ethiopia
- Correspondence: Abebe Muche Belete Department of Biochemistry, Medical Faculty, Debre Berhan University, P.O. Box 445, Debre Berhan, Ethiopia Email
| | - Daniel Seifu
- Department of Biochemistry, Division of Biomedical Sciences, University of Global Health Equity, Kigali, Rwanda
| | - Menakath Menon
- Department of Biochemistry, Medical Faculty, Addis Ababa University, Addis Ababa, Ethiopia
| | - Wondwossen Amogne
- Department of Internal Medicine, Medical Faculty, Addis Ababa University, Addis Ababa, Ethiopia
| | - Aster Shewa
- Department of Internal Medicine, Zewditu Memorial Hospital, Addis Ababa, Ethiopia
| | - Alemu Adela Tefera
- Department of Biochemistry, Medical Faculty, Debre Berhan University, Debre Berhan, Ethiopia
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Kato I, Tumaini B, Pallangyo K. Prevalence of non-communicable diseases among individuals with HIV infection by antiretroviral therapy status in Dar es Salaam, Tanzania. PLoS One 2020; 15:e0235542. [PMID: 32645054 PMCID: PMC7347196 DOI: 10.1371/journal.pone.0235542] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 06/18/2020] [Indexed: 12/18/2022] Open
Abstract
Background Long-term antiretroviral therapy has modified the clinical course of HIV infection to a chronic condition associated with increased risk of developing non-communicable diseases (NCDs). Information is scant, from sub-Saharan Africa, on the prevalence of NCDs and associated factors among individuals on ART. Methodology We consecutively enrolled individuals with HIV infection who were ART naïve and those on ART for ≥5 years (LTART) attending health facilities in Dar es Salaam. Participant's blood pressure, anthropometric measurements, and fasting blood glucose were recorded. Participants with impaired fasting blood glucose underwent an oral glucose tolerance test. A venous blood sample was sent to the lab for biochemical tests. Chi-square test was used to compare proportions, Poisson regression with robust standard errors was used to determine associations between variables. Results Overall, 612 individuals with HIV infection were enrolled, half of whom were ART naïve. Females comprised 71.9% and 68.0% of participants in the LTART and ART naïve study arms, respectively, p = 0.290. The mean age (±SD) was 44.9 ± 12.7 years and 37.5 ± 11.8 years among LTART and ART naïve participants, respectively, p<0.001. Hypertension was documented in 25.2% in those on LTART compared to 6.9% among ART naïve subjects, p<0.001. Impaired glucose tolerance was found in 22.9% and 4.6% among LTART compared to ART naïve subjects, p<0.001. Diabetes mellitus was detected in 17.0% of those on LTART compared to 3.9% ART naïve participants, p<0.001. Hypercholesterolemia was found in 30.4% of individuals on LTART compared to 16.7% of ART naïve subjects, p<0.001, and hypertriglyceridemia was found in 16.0% of participants on LTART compared to 9.5% of ART naïve, p = 0.015. LTART use, age ≥40 years, history of smoking, and body mass index were independently associated with NCDs. Conclusion Hypertension, impaired glucose tolerance, diabetes mellitus, hypercholesterolemia, and hypertriglyceridemia were associated with long-term use of antiretroviral drugs.
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Affiliation(s)
- Irene Kato
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- * E-mail:
| | - Basil Tumaini
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Kisali Pallangyo
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Changes in clinical indicators among human immunodeficiency virus patients who failed in antiretroviral therapy during 2004–2016 in Yunnan, China: an observational cohort study. GLOBAL HEALTH JOURNAL 2020. [DOI: 10.1016/j.glohj.2020.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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15
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Soares ALG, Banda L, Amberbir A, Jaffar S, Musicha C, Price A, Nyirenda MJ, Lawlor DA, Crampin A. Sex and area differences in the association between adiposity and lipid profile in Malawi. BMJ Glob Health 2019; 4:e001542. [PMID: 31565403 PMCID: PMC6747887 DOI: 10.1136/bmjgh-2019-001542] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/24/2019] [Accepted: 06/29/2019] [Indexed: 12/14/2022] Open
Abstract
Background Evidence from high-income countries shows that higher adiposity results in an adverse lipid profile, but it is unclear whether this association is similar in Sub-Saharan African (SSA) populations. This study aimed to assess the association between total and central adiposity measures and lipid profile in Malawi, exploring differences by sex and area of residence (rural/urban). Methods In this cross-sectional study, data from 12 096 rural and 12 847 urban Malawian residents were used. The associations of body mass index (BMI) and waist to hip ratio (WHR) with fasting lipids (total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C) and triglycerides (TG)) were assessed by area and sex. Results After adjusting for potential confounders, higher BMI and WHR were linearly associated with increased TC, LDL-C and TG and reduced HDL-C. BMI was more strongly related to fasting lipids than was WHR. The associations of adiposity with adverse lipid profile were stronger in rural compared with urban residents. For instance, one SD increase in BMI was associated with 0.23 mmol/L (95% CI 0.19 to 0.26) increase in TC in rural women and 0.13 mmol/L (95% CI 0.11 to 0.15) in urban women. Sex differences in the associations between adiposity and lipids were less evident. Conclusions The consistent associations observed of higher adiposity with adverse lipid profiles in men and women living in rural and urban areas of Malawi highlight the emerging adverse cardio-metabolic epidemic in this poor population. Our findings underline the potential utility of BMI in estimating cardiovascular risk and highlight the need for greater investment to understand the long-term health outcomes of obesity and adverse lipid profiles and the extent to which lifestyle changes and treatments effectively prevent and modify adverse cardio-metabolic outcomes.
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Affiliation(s)
- Ana Luiza G Soares
- Population Health Sciences, University of Bristol, Bristol, UK.,MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK, Bristol, UK
| | - Louis Banda
- Malawi Epidemiology and Intervention Research Unit (MEIRU), Lilongwe and Karonga, Malawi
| | - Alemayehu Amberbir
- Dignitas International, Zomba, Malawi.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Shabbar Jaffar
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Crispin Musicha
- Malawi Epidemiology and Intervention Research Unit (MEIRU), Lilongwe and Karonga, Malawi
| | - Alison Price
- Malawi Epidemiology and Intervention Research Unit (MEIRU), Lilongwe and Karonga, Malawi.,Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Moffat J Nyirenda
- Malawi Epidemiology and Intervention Research Unit (MEIRU), Lilongwe and Karonga, Malawi.,Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Debbie A Lawlor
- Population Health Sciences, University of Bristol, Bristol, UK.,MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK, Bristol, UK
| | - Amelia Crampin
- Malawi Epidemiology and Intervention Research Unit (MEIRU), Lilongwe and Karonga, Malawi.,Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK
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Chireshe R, Naidoo K, Nyamakura R. Hypertension among human immunodeficiency virus infected patients on treatment at Parirenyatwa Hospital: A descriptive study. Afr J Prim Health Care Fam Med 2019; 11:e1-e8. [PMID: 31478742 PMCID: PMC6739546 DOI: 10.4102/phcfm.v11i1.1974] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 02/24/2019] [Accepted: 03/01/2019] [Indexed: 02/03/2023] Open
Abstract
Background Since the roll-out of antiretroviral therapy (ART) in sub-Saharan Africa (sSA) in the early 2000s, the life expectancy of people infected with the human immunodeficiency virus (HIV) has increased. However, the gains made in reducing mortality from HIV-related complications have been mitigated by the emergence of age-related chronic non-communicable diseases (NCDs), such as hypertension. Protease inhibitors (PIs), and prolonged exposure to highly active ART (HAART) have been implicated in the development of hypertension in HIV-positive people. Aim To investigate the prevalence of hypertension and its associated risk factors among HIV-positive patients receiving ART. Setting The study was carried out at an urban-based clinic that provides HAART and primary care to HIV-positive people in Harare, Zimbabwe. Methods A descriptive, cross-sectional study was conducted among non-pregnant adults on HAART attending the clinic between July and August 2018. Results We studied 600 HIV-positive adult patients, of which 56% were women. The prevalence rate of hypertension was 29.9%. Of the participants in the hypertensive group, 11.2% were not previously diagnosed or on treatment. Factors associated with hypertension were advanced age, use of HAART for longer than 10 years, being overweight, a family history of hypertension and smoking. There was a 68.8% prevalence of body mass index greater than 25 kg/m2 among all participants. Conclusion High hypertension prevalence was recorded. Hypertension was not associated with gender or use of PI regimens but being overweight was highly prevalent. Greater vigilance and integration of resources is required in the overall treatment and monitoring of HIV-positive patients for co-morbidities.
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Affiliation(s)
- Rumbidzai Chireshe
- Discipline of Nursing and Public Health, University of KwaZulu-Natal, Durban.
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Wu Q, Zhang D, Zhao Q, Liu L, He Z, Chen Y, Huang H, Hou Y, Yang X, Gu J. Effects of transitional health management on adherence and prognosis in elderly patients with acute myocardial infarction in percutaneous coronary intervention: A cluster randomized controlled trial. PLoS One 2019; 14:e0217535. [PMID: 31150451 PMCID: PMC6544260 DOI: 10.1371/journal.pone.0217535] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 05/14/2019] [Indexed: 12/14/2022] Open
Abstract
Purpose This study aimed to assess the effects of transitional health management on adherence and prognosis in elderly patients with acute myocardial infarction undergoing percutaneous coronary intervention. Methods We conducted the trial from June 2016 to December 2016. A total of one hundred and fifty patients with acute myocardial infarction after PCI who met the inclusion criteria were randomly divided into an experimental (n = 75) group and a control (n = 75) group. The participants in the experimental group received transitional health management for three months. The two groups of patients were evaluated for treatment adherence, quality of life, clinical indicators, adverse cardiovascular events and statistics regarding readmission rates at baseline and 6 months after discharge. Results Compared with the controls, patients in the intervention group demonstrated better medication adherence, reexamination adherence, healthy lifestyle and clinical indicators (all P<0.05) and lower rates of adverse cardiovascular events and readmission (all P<0.05). Conclusion Transitional health management effectively improved adherence in elderly patients with acute myocardial infarction after PCI, ameliorated clinical indicators, and effectively reduced the incidence of adverse cardiovascular events and readmission rates. Transitional health management was an effective intervention for PCI patients after discharge.
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Affiliation(s)
- Qing Wu
- Nursing Department, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Dandan Zhang
- Nursing Department, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Qi Zhao
- Department of Radiotherapy, The First Affiliated Hospital of Soochow University, Suzhou, China
- * E-mail:
| | - Lin Liu
- Nursing Department, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhisong He
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yan Chen
- Nursing Department, the 2 Affiliated Hospital of Soochow University, Suzhou, China
| | - Hui Huang
- Nursing Department, the 2 Affiliated Hospital of Soochow University, Suzhou, China
| | - Yunyin Hou
- Nursing Department, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaofang Yang
- Nursing Department, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jie Gu
- Nursing Department, The First Affiliated Hospital of Soochow University, Suzhou, China
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Amberbir A, Banda V, Singano V, Matengeni A, Pfaff C, Ismail Z, Allain TJ, Chan AK, Sodhi SK, van Oosterhout JJ. Effect of cardio-metabolic risk factors on all-cause mortality among HIV patients on antiretroviral therapy in Malawi: A prospective cohort study. PLoS One 2019; 14:e0210629. [PMID: 30653539 PMCID: PMC6336397 DOI: 10.1371/journal.pone.0210629] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 12/29/2018] [Indexed: 01/27/2023] Open
Abstract
Background Cardiovascular disease (CVD) risk among people living with HIV is elevated due to persistent inflammation, hypertension and diabetes comorbidity, lifestyle factors and exposure to antiretroviral therapy (ART). Data from Africa on how CVD risk affects morbidity and mortality among ART patients are lacking. We explored the effect of CVD risk factors and the Framingham Risk Score (FRS) on medium-term ART outcomes. Methods A prospective cohort study of standardized ART outcomes (Dead, Alive on ART, stopped ART, Defaulted and Transferred out) was conducted from July 2014—December 2016 among patients on ART at a rural and an urban HIV clinic in Zomba district, Malawi. The primary outcome was Dead. Active defaulter tracing was not done and patients who transferred out and defaulted were excluded from the analysis. At enrolment, hypertension, diabetes and dyslipidemia were diagnosed, lifestyle data collected and the FRS was determined. Cox-regression analysis was used to determine independent risk factors for the outcome Dead. Results Of 933 patients enrolled, median age was 42 years (IQR: 35–50), 72% were female, 24% had hypertension, 4% had diabetes and 15.8% had elevated total cholesterol. The median follow up time was 2.4 years. Twenty (2.1%) patients died, 50 (5.4%) defaulted, 63 (6.8%) transferred out and 800 (85.7%) were alive on ART care (81.7% urban vs. 89.9% rural). In multivariable survival analysis, male gender (aHR = 3.28; 95%CI: 1.33–8.07, p = 0.01) and total/HDL cholesterol ratio (aHR = 5.77, 95%CI: 1.21–27.32; p = 0.03) were significantly associated with mortality. There was no significant association between mortality and hypertension, body mass index, central obesity, diabetes, FRS, physical inactivity, smoking at enrolment, ART regimen and WHO disease stage. Conclusions Medium-term all-cause mortality among ART patients was associated with male gender and elevated total/HDL cholesterol ratio.
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Affiliation(s)
| | | | | | | | | | | | - Theresa J. Allain
- Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Adrienne K. Chan
- Dignitas International, Zomba, Malawi
- Division of Infectious Diseases, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Sumeet K. Sodhi
- Dignitas International, Zomba, Malawi
- Department of Family and Community Medicine, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Joep J. van Oosterhout
- Dignitas International, Zomba, Malawi
- Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
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