Walter Reed Army Institute of Research, Silver Spring, MD, USA.
Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.
Lancet HIV. 2022 Mar;9 Suppl 1:S5. doi: 10.1016/S2352-3018(22)00070-4.
The lifespan of people living with HIV is increasing, and non-communicable diseases (NCDs) are becoming an important driver of morbidity in this population. We examined the prevalence of NCDs in older people with HIV and factors associated with development of NCDs.
The African Cohort Study is a prospective cohort enrolling adults with and without HIV at 12 sites in Kenya, Tanzania, Uganda, and Nigeria. Using data collected from Jan 21, 2013 to June 30, 2021, we assessed the prevalence and odds of NCDs, including renal insufficiency (estimated glomerular filtration rate [GFR] <60 mL/min/1·73 m²), elevated blood pressure (any systolic blood pressure >139 mm Hg or diastolic BP >89 mm Hg), obesity (body mass index >30), diabetes (fasting glucose ≥126 mg/dL or receiving medication for diabetes) or hyperglycaemia (fasting glucose ≥99 mg/dL or non-fasting ≥199 mg/dL). Diabetes and hyperglycaemia were collectively evaluated as dysglycaemia. We used multivariable logistic regression with generalised estimating equations to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for factors associated with NCDs. Diabetes and hyperglycaemia models were adjusted for potential confounders including study site and sex. Renal insufficiency models had similar adjustments with the addition of elevated blood pressure and hyperglycaemia.
Of 3434 participants, 2003 (59·3%) were female and 1431 (40·7%) were male, and 2949 (85·9%) were living with HIV. Of people living with HIV, 2188 (74·2%) were younger than 50 years and 761 (25·8%) were aged 50 years or older. Among people living with HIV aged 50 or older, 27·5% (n=209 had elevated blood pressure, 13·4% (102) had dysglycaemia, 4·3% (33) had renal insufficiency, and 11·7% (89) had obesity at last visit. Compared with people without HIV under 50, people living with HIV aged 50 or older had increased adjusted odds of having diabetes (5·29, 95% CI 2·61-10·70), hyperglycaemia (1·86, 1·38-2·50), and renal insufficiency (6·37, 2·38-17·1). We found no differences between individuals aged 50 years or older with and without HIV for diabetes, hyperglycaemia, and renal insufficiency.
There was a high burden of NCDs in this cohort. HIV status was not associated with NCD prevalence, although the study was probably underpowered to detect such an association. Screening and treatment for common NCDs, such as raised blood pressure and dysglycaemia, should be considered as part of HIV integrated care. Such an approach might help to prevent other NCDs, such as renal insufficiency, and improve the span of healthy life.
PEPFAR via cooperative agreements between HJF and the US Department of Defense.
随着感染艾滋病毒人群的寿命延长，非传染性疾病（NCDs）成为该人群发病的主要原因。本研究旨在调查老年艾滋病毒感染者中非传染性疾病的流行情况及其相关影响因素。
本研究为前瞻性队列研究，纳入了来自肯尼亚、坦桑尼亚、乌干达和尼日利亚 12 个研究点的 HIV 感染者和非感染者。我们利用 2013 年 1 月 21 日至 2021 年 6 月 30 日收集的数据，评估了非传染性疾病的患病率和发病风险，包括肾功能不全（估算肾小球滤过率[GFR]＜60ml/min/1.73m²）、高血压（任何收缩压＞139mmHg 或舒张压＞89mmHg）、肥胖（体重指数＞30）、糖尿病（空腹血糖≥126mg/dL 或正在服用糖尿病药物）或高血糖（空腹血糖≥99mg/dL 或非空腹血糖≥199mg/dL）。糖尿病和高血糖合并为糖代谢异常。我们使用广义估计方程的多变量逻辑回归来评估与非传染性疾病相关的因素的比值比（OR）和 95%置信区间（CI）。糖尿病和高血糖模型根据研究地点和性别等潜在混杂因素进行了调整。肾功能不全模型具有类似的调整，同时还增加了高血压和高血糖。
本研究共纳入 3434 名参与者，其中 2003 名（59.3%）为女性，1431 名（40.7%）为男性，2949 名（85.9%）为 HIV 感染者。在 HIV 感染者中，2188 名（74.2%）年龄小于 50 岁，761 名（25.8%）年龄为 50 岁或以上。在年龄 50 岁或以上的 HIV 感染者中，27.5%（209 人）患有高血压，13.4%（102 人）患有糖代谢异常，4.3%（33 人）患有肾功能不全，11.7%（89 人）患有肥胖。与 50 岁以下无 HIV 感染者相比，年龄 50 岁或以上的 HIV 感染者患有糖尿病的调整后比值比（OR）为 5.29（95%CI 2.61-10.70）、高血糖的 OR 为 1.86（1.38-2.50）、肾功能不全的 OR 为 6.37（2.38-17.1）。我们没有发现年龄 50 岁或以上的 HIV 感染者与无 HIV 感染者在糖尿病、高血糖和肾功能不全方面存在差异。
本研究队列中非传染性疾病的负担很高。HIV 状况与非传染性疾病的患病率无关，但本研究可能没有足够的能力来检测到这种关联。应该考虑将常见的非传染性疾病（如高血压和糖代谢异常）的筛查和治疗作为 HIV 综合护理的一部分。这种方法可能有助于预防其他非传染性疾病，如肾功能不全，并延长健康寿命。
美国国际开发署通过 HJF 与美国国防部之间的合作协议向 PEPFAR 提供资助。
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