Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
J Int AIDS Soc. 2019 Mar;22(3):e25213. doi: 10.1002/jia2.25213.
Participation in antiretroviral therapy (ART) programmes has been associated with greater utilization of care for hypertension and diabetes in rural South Africa. The objective of this study was to assess whether people living with HIV on ART with comorbid hypertension or diabetes also have improved chronic disease management indicators.
The Health and Aging in Africa: a longitudinal study of an INDEPTH Community in South Africa (HAALSI) is a cohort of 5059 adults >40 years old. Enrollment took place between November 2014 and November 2015. The study collected population-based data on demographics, healthcare utilization, height, weight, blood pressure (BP) and blood glucose as well as HIV infection, HIV-1 RNA viral load (VL) and ART exposure. We used regression models to determine whether HIV care cascade stage (HIV-negative, HIV+ /No ART, ART/Detected HIV VL, and ART/Undetectable VL) was associated with diagnosis or treatment of hypertension or diabetes, and systolic blood pressure and glucose among those with diagnosed hypertension or diabetes. ART use was measured from drug level testing on dried blood spots.
Compared to people without HIV, ART/Undetectable VL was associated with greater awareness of hypertension diagnosis (adjusted risk ratio (aRR) 1.18, 95% CI: 1.09 to 1.28) and treatment of hypertension (aRR 1.24, 95% CI: 1.10 to 1.41) among those who met hypertension diagnostic criteria. HIV care cascade stage was not significantly associated with awareness of diagnosis or treatment of diabetes. Among those with diagnosed hypertension or diabetes, ART/Undetectable VL was associated with lower mean systolic blood pressure (5.98 mm Hg, 95% CI: 9.65 to 2.32) and lower mean glucose (3.77 mmol/L, 95% CI: 6.85 to 0.69), compared to being HIV-negative.
Participants on ART with an undetectable VL had lower systolic blood pressure and blood glucose than the HIV-negative participants. HIV treatment programmes may provide a platform for health systems strengthening for cardiometabolic disease.
在南非农村，参与抗逆转录病毒疗法（ART）项目与高血压和糖尿病的治疗利用率提高有关。本研究的目的是评估同时患有高血压或糖尿病的艾滋病毒感染者接受抗逆转录病毒治疗（ART）后，其慢性疾病管理指标是否得到改善。
非洲的健康和老龄化：南非一个 INDEPTH 社区的纵向研究（HAALSI）是一个由 5059 名年龄在 40 岁以上的成年人组成的队列。招募工作于 2014 年 11 月至 2015 年 11 月进行。该研究收集了人口统计学、医疗保健利用、身高、体重、血压（BP）和血糖以及艾滋病毒感染、HIV-1 RNA 病毒载量（VL）和抗逆转录病毒治疗暴露等方面的基于人群的数据。我们使用回归模型来确定 HIV 护理级联阶段（HIV 阴性、HIV+/无 ART、ART/检测到 HIV VL 和 ART/未检测到 VL）是否与高血压或糖尿病的诊断或治疗以及诊断为高血压或糖尿病者的收缩压和血糖有关。ART 使用是通过对干血斑进行药物水平检测来衡量的。
与未感染 HIV 的人相比，在符合高血压诊断标准的人群中，ART/未检测到 VL 与高血压诊断意识（调整风险比[aRR]为 1.18，95%CI：1.09 至 1.28）和高血压治疗（aRR 为 1.24，95%CI：1.10 至 1.41）显著相关。HIV 护理级联阶段与糖尿病诊断或治疗的意识无显著相关性。在诊断为高血压或糖尿病的人群中，与 HIV 阴性人群相比，ART/未检测到 VL 与较低的平均收缩压（5.98mmHg，95%CI：9.65 至 2.32）和较低的平均血糖（3.77mmol/L，95%CI：6.85 至 0.69）相关。
VL 无法检测到的接受 ART 治疗的参与者的收缩压和血糖低于 HIV 阴性参与者。艾滋病毒治疗方案可能为加强心血管代谢疾病的卫生系统提供一个平台。
