Yendewa George A, Lakoh Sulaiman, Jiba Darlinda F, Yendewa Sahr A, Barrie Umu, Deen Gibrilla F, Samai Mohamed, Jacobson Jeffrey M, Sahr Foday, Salata Robert A
Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA.
Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA.
J Clin Med. 2022 Jun 16;11(12):3466. doi: 10.3390/jcm11123466.
Noncommunicable diseases (NCDs) are a growing public health concern in low- and middle-income countries and disproportionately affect people living with HIV (PWH). Hepatitis B virus (HBV) and tuberculosis (TB) coinfection are presumed risk factors in endemic settings; however, supporting evidence is conflicting. We analyzed baseline data of newly diagnosed PWH prospectively enrolled in the Sierra Leone HIV Cohort Study in Freetown, Sierra Leone, from March to September 2021. Logistic regression was used to identify associations between NCDs, HBV and TB. A total of 275 PWH aged ≥18 years were studied (55% female, median age 33 years, median CD4 307 cells/mm3, 15.3% HIV/HBV, 8.7% HIV/TB). NCDs were bimodally distributed, with 1 in 4 PWH clustered around liver disease (fibrosis/cirrhosis), diabetes/prediabetes and obesity/preobesity, while 1 in 8 had renal impairment or hypertension (HTN). Overall, 41.5% had ≥1 NCD, while 17.5% were multimorbid (≥2 NCDs). After adjusting for age, sex, sociodemographic factors and CD4 count, liver fibrosis/cirrhosis was strongly associated with HBV (aOR 8.80, 95% CI [2.46−31.45]; p < 0.001) and diabetes/prediabetes (aOR 9.89, 95% CI [1.14−85.67]; p < 0.037). TB independently predicted diabetes/prediabetes (aOR 7.34, 95% CI [1.87−28.74]; p < 0.004), while renal impairment was associated with proteinuria (aOR 9.34, 95% CI [2.01−43.78]; p < 0.004) and HTN (aOR 6.00, 95% CI [1.10−35.39]; p < 0.049). Our findings warrant the implementation of NCD-aware HIV programs for the prevention, early detection and management of comorbidities.
非传染性疾病（NCDs）在低收入和中等收入国家正日益引起公共卫生关注，且对艾滋病毒感染者（PWH）的影响尤为严重。在地方流行地区，乙型肝炎病毒（HBV）和结核病（TB）合并感染被认为是风险因素；然而，支持这一观点的证据并不一致。我们分析了2021年3月至9月在塞拉利昂弗里敦前瞻性纳入塞拉利昂艾滋病毒队列研究的新诊断PWH的基线数据。采用逻辑回归分析来确定非传染性疾病、HBV和TB之间的关联。共研究了275名年龄≥18岁的PWH（55%为女性，中位年龄33岁，中位CD4为307个细胞/mm³，15.3%为HIV/HBV，8.7%为HIV/TB）。非传染性疾病呈双峰分布，四分之一的PWH集中在肝病（纤维化/肝硬化）、糖尿病/糖尿病前期和肥胖/肥胖前期，而八分之一的人有肾功能损害或高血压（HTN）。总体而言，41.5%的人患有≥1种非传染性疾病，而17.5%的人患有多种疾病（≥2种非传染性疾病）。在调整年龄、性别、社会人口学因素和CD4计数后，肝纤维化/肝硬化与HBV（调整后比值比[aOR] 8.80，95%置信区间[CI] [2.46 - 31.45]；p < 0. .001）和糖尿病/糖尿病前期（aOR 9.89，95% CI [1.14 - 85.67]；p < 0.037）密切相关。TB独立预测糖尿病/糖尿病前期（aOR 7.34，95% CI [1.87 - 28.74]；p < 0.004），而肾功能损害与蛋白尿（aOR 9.34，95% CI [2.01 - 43.78]；p < 0.004）和HTN（aOR 6.00，95% CI [1.10 - 35.39]；p < 0.049）相关。我们的研究结果表明有必要实施关注非传染性疾病的艾滋病毒项目，以预防、早期发现和管理合并症。
