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Noninfectious Comorbidity in the African Cohort Study

2018; Oxford University Press; Volume: 69; Issue: 4 Linguagem: Inglês

10.1093/cid/ciy981

1537-6591

Julie A. Ake, Christina S. Polyak, Trevor A. Crowell, Francis Kiweewa, Michael Semwogerere, Lucas Maganga, Emmanuel Bahemana, Jonah Maswai, Rither Langat, John Owuoth, Solomon Otieno, Babajide Keshinro, Allahna Esber, Michelle Liu, Leigh Anne Eller, Kavitha Ganesan, Ajay Parikh, Tiffany E. Hamm, Merlin L. Robb, Patrick W. Hickey, Victor Valcour, Nelson L. Michael, O. Falodun, Kevin Song, Mark Milazzo, Chi Zhang, R Deshano, Callie M Thompson, Genevieve Smith, Tsedal Mebrahtu, Peter Coakley, Kara Lombardi, Michelle Imbach, Sheila A. Peel, Jennifer Malia, Arne Kroidl, Inge Kroidl, Christof Geldmacher, Cate Kafeero, A Nambuya, Josephine Tegamanyi, Harriet Birungi, Olive Mugagga, G Nassali, Paul Wangiri, M. Nantabo, P. Nambulondo, Brenda Atwijuka, Ambrose Asiimwe, Christine Nabanoba, Michael Semwogerere, Robert Mwesigwa, S. Jjuuko, Rosemary Namagembe, E. Bagyendagye, Allan Tindikahwa, Ivan Rwomushana, F. Ssentongo, Hannah Kibuuka, Monica Millard, Joan Kapkiai, Salome Wangare, R. Mangesoi, Philemon C Chepkwony, L. Bor, E. Maera, Alex Kasembeli, J. Rotich, Carolyne Kipkoech, Winnie Chepkemoi, Agnes J Rono, Zeddy Bett Kesi, Janet Ngeno, Edwin Langat, Kennedy Labosso, Ken Langat, Risper Kirui, Linner Rotich, M. Mabwai, Ella Chelangat, Jeam Otieno Agutu, C. Tonui, Enock Changwony, Mike Bii, Ezekiel Chumba, Julius Korir, Janet Sugut, Danson Gitonga, Robert Ngetich, Samuel Kiprotich, Winne Rehema, Celine Ogari, Irene A Ouma, Oscar Adimo, С. Огай, Charles Okwaro, Elias K. Maranga, J Ochola, Kennedy Obambo, Valentine Sing’oei, L. H. Otieno, O. Nyapiedho, Nicolette G.C. van der Sande, Elizabeth A. Odemba, F. Wanjiru, Samoel Khamadi, Evarist Chiweka, Anange Lwilla, Dorothy Mkondoo, Nancy Somi, Paschal Kiliba, Mtasi Mwaipopo, Gwamaka Mwaisanga, Joy Muhumuza, N. Mkingule, O. Mwasulama, A. Sanagare, Peter Kishimbo, Gloria L. David, Faraja Mbwayu, Jaquiline Mwamwaja, Janeth Likiliwike, Joy Muhumuza, Ruby Mcharo, N. Mkingule, O. Mwasulama, Bariki Mtafya, Cornelia Lueer, Abisai Kisinda, T. Mbena, Hawa Mfumbulwa, Laban Mwandumbya, Peter Edwin, Willyhelmina Olomi, Yakubu Adamu, Adeyinka Oye Akintunde, Abdulwasiu Bolaji Tiamiyu, Afoke Kokogho, Mohammed Sani Shehu, Nkechinyere Elizabeth Harrison, Uzoamaka Concilia Agbaim, O.A Adegbite, Rachel Eluwa, Gabriela Adelakun, A U Ikegbunam, J C Mbibi, Folake Oni, R.O Ndbuisi, Jacintal Elemere, Nnamdi Azuakola, Thomas Williams, Miriam Ayogu, O. Enameguono, Ariake Odo, I.C. Ukaegbu, Oscar Ugwuezumba, Samson Olalekan Odeyemi, Ndubuisis Okeke, L Umeji, Alice Rose, Hanna Daniel, H. Nwando, E.I. Nicholas, Temiloluwa Ololade Iyanda, Chidinma Okolo, V.Y. Mene, Banenat B. Dogonyaro, O. Olabulo, O. Akinseli, F. Onukun, G Knopp,

HIV Research and Treatment

Abstract Background Noninfectious comorbid diseases (NCDs) contribute to morbidity and mortality in human immunodeficiency virus (HIV)–infected populations in resource-rich countries. With antiretroviral therapy (ART) scale-up in Africa, understanding burden NCD informs public health strategy. Methods At enrollment, participants at 11 HIV clinics in Kenya, Uganda, Tanzania, and Nigeria underwent medical history, physical, laboratory, and neuropsychological assessments to identify elevated blood pressure, hypercholesterolemia, dysglycemia, renal insufficiency, and cognitive impairment. Poisson regression models estimated adjusted relative risks (ARRs) and 95% confidence intervals (CIs) for the number of NCDs associated with factors of interest. Logistic regression was used to evaluate each NCD separately among HIV-infected participants. Results Among 2720 participants with complete NCD data, 2159 (79.4%) were HIV-infected. Of those, 1426 (66.0%) were taking ART and 813 (37.7%) had at least 1 NCD. HIV infection was associated with more NCDs, especially with ART (ARR, 1.42; 95% CI, 1.22–1.66). In addition to age, body mass index, and program site, ART usage was associated with more NCDs (ARR, 1.50; 95% CI, 1.27–1.78 for virologically suppressed and ARR, 1.38; 95% CI, 1.13–1.68 for viremic) among HIV-infected participants. In participants taking ART, CD4 nadir below 200 cells/mm3 was associated with more NCDs (ARR, 1.43; 95% CI, 1.06–1.93). ART use was independently associated with hypercholesterolemia and dysglycemia. Program site was significantly associated with all comorbidities except renal insufficiency. Conclusions HIV infection was a risk for NCDs, which were common in HIV-infected participants, geographically variable, and largely consistent with metabolic complications of first-line ART.