Noninfectious Comorbidity in the African Cohort Study
Authors: Ake Julie A , Polyak Christina S , Crowell Trevor A , Kiweewa Francis , Semwogerere Michael , Maganga Lucas , Bahemana Emmanuel , Maswai Jonah , Langat Rither , Owuoth John , Otieno Solomon , Keshinro Babajide , Esber Allahna L , Liu Michelle , Eller Leigh Anne , Ganesan Kavitha , Parikh Ajay P , Hamm Tiffany E , Robb Merlin L , Hickey Patrick W , Valcour Victor G , Michael Nelson L ,   African Cohort Study Team, Falodun O , Song K , Milazzo M , Zhang C , Deshano R , Thompson C , Smith G , Mebrahtu T , Coakley P , Lombardi K , Imbach M , Peel S , Malia J , Kroidl A , Kroidl I , Geldmacher C , Kafeero C , Nambuya A , Tegamanyi J , Birungi H , Mugagga O , Nassali G , Wangiri P , Nantabo M , Nambulondo P , Atwijuka B , Asiimwe A , Nabanoba C T , Semwogerere M , Mwesigwa R , Jjuuko S , Namagembe R , Bagyendagye E , Tindikahwa A , Rwomushana I , Ssentongo F , Kibuuka H , Millard M , Kapkiai J , Wangare S , Mangesoi R , Chepkwony P , Bor L , Maera E , Kasembeli A , Rotich J , Kipkoech C , Chepkemoi W , Rono A , Kesi Z , Ngeno J , Langat E , Labosso K , Langat K , Kirui R , Rotich L , Mabwai M , Chelangat E , Agutu J , Tonui C , Changwony E , Bii M , Chumba E , Korir J , Sugut J , Gitonga D , Ngetich R , Kiprotich S , Rehema W , Ogari C , Ouma I , Adimo O , Ogai S , Okwaro C , Maranga E , Ochola J , Obambo K , Sing’oei V , Otieno L , Nyapiedho O , Sande N , Odemba E , Wanjiru F , Khamadi S , Chiweka E , Lwilla A , Mkondoo D , Somi N , Kiliba P , Mwaipopo M , Mwaisanga G , Muhumuza J , Mkingule N , Mwasulama O , Sanagare A , Kishimbo P , David G , Mbwayu F , Mwamwaja J , Likiliwike J , Muhumuza J , Mcharo R , Mkingule N , Mwasulama O , Mtafya B , Lueer C , Kisinda A , Mbena T , Mfumbulwa H , Mwandumbya L , Edwin P , Olomi W , Adamu Y , Akintunde A , Tiamiyu A B , Afoke K , Shehu M , Harrison N E , Agbaim U C , Adegbite O A , Eluwa R M , Adelakun G A , Ikegbunam A U , Mbibi J C , Oni F O , Ndbuisi R O , Elemere J , Azuakola N , Williams T T , Ayogu M , Enameguono O , Odo A F , Ukaegbu I C , Ugwuezumba O , Odeyemi S O , Okeke N C , Umeji L , Rose A , Daniel H , Nwando H , Nicholas E I , Iyanda T , Okolo C , Mene V Y , Dogonyaro B , Olabulo O , Akinseli O , Onukun F , Knopp G 
Published: November 2018

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.