Romo Matthew L, Dear Nicole, Crowell Trevor A, Frndak Seth, Parikh Ajay P, Kibuuka Hannah, Owuoth John, Sing'oei Valentine, Maswai Jonah, Bahemana Emmanuel, Anyebe Victor, Parker Zahra, Ake Julie A, Cavanaugh J Sean, Shah Neha
U.S. Military HIV Research Program, CIDR, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America.
Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, United States of America.
PLOS Glob Public Health. 2025 Apr 29;5(4):e0004464. doi: 10.1371/journal.pgph.0004464. eCollection 2025.
Hypertension and diabetes are increasingly important contributors to morbidity and mortality in African countries, including among people living with HIV (PLWH) who are on lifelong antiretroviral therapy. However, local HIV care programs have historically not included management of noncommunicable diseases. The African Cohort Study enrolls PLWH and people living without HIV (PLWoH) aged 15 years and older who are receiving clinical care at 12 PEPFAR-supported health facilities in Kenya, Nigeria, Tanzania, and Uganda. Participants undergo clinical assessments and medical record review every six months. We defined hypertension as a persistently elevated systolic and/or diastolic blood pressure ≥140/90 mmHg at two consecutive 6-monthly visits or receipt of hypertension medication. We defined diabetes as a single study visit with a fasting plasma glucose ≥7.0 mmol/L and/or non-fasting plasma glucose ≥11.1 mmol/L or receipt of diabetes medication. We computed descriptive statistics for hypertension/diabetes prevalence and treatment and used random intercept models adjusted for demographic and clinical characteristics to examine predictors of untreated hypertension and diabetes. From 2013 through 2023, among 3617 participants, 692 (19.1%) met our definition of hypertension, with a prevalence of 19.5% among PLWH and 17.3% among PLWoH; 276 (39.9%) received hypertension treatment. No significant difference in untreated hypertension was found comparing PLWH with PLWoH (adjusted risk ratio [aRR] 0.93, 95% confidence interval [CI]: 0.84-1.04). Among 3995 participants, 253 (6.3%) met our definition of diabetes, with a prevalence of 6.6% among PLWH and 4.7% among PLWoH; 51 (20.2%) received diabetes treatment. No significant difference in untreated diabetes was found comparing PLWH with PLWoH (aRR 1.01, 95% CI: 0.91-1.12). The high burden of untreated hypertension and diabetes among PLWH and PLWoH highlight the need for integrated non-communicable disease management within existing HIV services and strengthening of primary healthcare systems.
高血压和糖尿病对非洲国家的发病率和死亡率的影响日益显著，在接受终身抗逆转录病毒治疗的艾滋病毒感染者（PLWH）中亦是如此。然而，当地的艾滋病毒护理项目历来未涵盖非传染性疾病的管理。非洲队列研究纳入了年龄在15岁及以上、在肯尼亚、尼日利亚、坦桑尼亚和乌干达的12个由总统艾滋病紧急救援计划（PEPFAR）资助的医疗机构接受临床护理的艾滋病毒感染者和未感染艾滋病毒的人（PLWoH）。参与者每六个月接受一次临床评估和病历审查。我们将高血压定义为在连续两次为期6个月的就诊时收缩压和/或舒张压持续升高≥140/90 mmHg，或正在接受高血压药物治疗。我们将糖尿病定义为在单次研究就诊时空腹血糖≥7.0 mmol/L和/或非空腹血糖≥11.1 mmol/L，或正在接受糖尿病药物治疗。我们计算了高血压/糖尿病患病率及治疗情况的描述性统计数据，并使用针对人口统计学和临床特征进行调整的随机截距模型来研究未经治疗的高血压和糖尿病的预测因素。从2013年到2023年，在3617名参与者中，692人（19.1%）符合我们对高血压的定义，艾滋病毒感染者中的患病率为19.5%，未感染艾滋病毒的人中患病率为17.3%；276人（39.9%）接受了高血压治疗。在比较艾滋病毒感染者和未感染艾滋病毒的人时，未发现未经治疗的高血压有显著差异（调整风险比[aRR]为0.93，95%置信区间[CI]：0.84 - 1.04）。在3995名参与者中，253人（6.3%）符合我们对糖尿病的定义，艾滋病毒感染者中的患病率为6.6%，未感染艾滋病毒的人中患病率为4.7%；51人（20.2%）接受了糖尿病治疗。在比较艾滋病毒感染者和未感染艾滋病毒的人时，未发现未经治疗的糖尿病有显著差异（aRR为1.01，95% CI：0.91 - 1.12）。艾滋病毒感染者和未感染艾滋病毒的人当中未经治疗的高血压和糖尿病负担沉重，这凸显了在现有艾滋病毒服务中进行非传染性疾病综合管理以及加强初级医疗保健系统的必要性。
