Muriuki Patrick Kiogora, Ngayo Musa Otieno, Njire Moses, Mungiria Juster, Nyanya Winfred Asiko, Owuor Daniel, Ndung'u Perpetual
Department of Medical Laboratory Science, Jomo Kenyatta University of Agriculture and Technology, Kenya.
Centre of Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.
PLOS Glob Public Health. 2025 Jun 20;5(6):e0004212. doi: 10.1371/journal.pgph.0004212. eCollection 2025.
Human Immunodeficiency Virus (HIV) and tuberculosis (TB) continue to pose a significant health burden in Kenya. Countries with the highest rates of people living with HIV (PLWH) also have a high prevalence of non-communicable diseases (NCDs), including type 2 diabetes (T2D) and hypertension (HPT). This study evaluated the burden and factors associated with T2D, HPT, and TB, including resistant strains among PLWH receiving antiretroviral therapy (ART) in Eastern Kenya. Blood and sputum samples, and baseline information were collected from 280 consenting PLWH. The participants' blood pressure (BP), glycated hemoglobin (HbA1c), CD4 cell counts, HIV viral load, full blood count, blood chemistry, and Rifampicin resistance were assessed. The mean (SD) age of the participants was 35.6 (±9.8) years, and a median (IQR) duration of living with HIV of 7 (4 -8) years. Most participants, 179 (63.9%), were HIV mono-infected, with 58 (20.7%) HIV/TB, 42 (15%) HIV/T2D, and 33 (11.8%) HIV/HPT dual comorbidities reported. Triple comorbidities reported included 18 (6.4%) HIV/T2D/HPT, 9 (3.2%) HIV/TB/T2D, and 9 (3.2%) HIV/TB/HPT, with 4 (1.4%) HIV/TB/T2D/HPT quadruple comorbidity reported. Six (2.1%) multidrug-resistant TB coinfections were detected. In multivariate analyses, being on ARV only (aOR 0.5; 95% CI 0.4 - 0.6, p = 0.0001) and achieving virological suppression (aOR 0.8; 95% CI 0.6 - 0.9, p = 0.017) were protective against HIV/TB coinfection. Previous hospital admission (aOR 1.2; 95% CI 1.1 - 1.4, p = 0.049) and previous TB infection (aOR 1.6; 95% CI 1.0 - 3.0, p = 0.034) were associated with HIV/TB coinfection. The PLWH in Eastern Kenya continues to experience a syndemic of NCDs and TB, including resistant strains. Consistent adherence to ART is crucial for achieving viral suppression; these are protective against NCDs and TB among PLWH. The findings highlight the necessity of integrating NCD management with HIV and TB treatment programs in Kenya.
人类免疫缺陷病毒（HIV）和结核病（TB）继续给肯尼亚带来重大的健康负担。HIV感染者（PLWH）比例最高的国家，非传染性疾病（NCDs）的患病率也很高，包括2型糖尿病（T2D）和高血压（HPT）。本研究评估了肯尼亚东部接受抗逆转录病毒治疗（ART）的PLWH中T2D、HPT和TB的负担及相关因素，包括耐药菌株。从280名同意参与的PLWH中采集了血液和痰液样本以及基线信息。评估了参与者的血压（BP）、糖化血红蛋白（HbA1c）、CD4细胞计数、HIV病毒载量、全血细胞计数、血液生化以及利福平耐药性。参与者的平均（标准差）年龄为35.6（±9.8）岁，感染HIV的中位（四分位间距）时长为7（4 - 8）年。大多数参与者，即179名（63.9%）为HIV单一感染，报告有58名（20.7%）为HIV/TB双重感染，42名（15%）为HIV/T2D双重感染，33名（11.8%）为HIV/HPT双重合并症。报告的三重合并症包括18名（6.4%）HIV/T2D/HPT，9名（3.2%）HIV/TB/T2D，以及9名（3.2%）HIV/TB/HPT，报告有4名（1.4%）为HIV/TB/T2D/HPT四重合并症。检测到6名（2.1%）多重耐药结核病合并感染。在多变量分析中，仅接受抗逆转录病毒治疗（aOR 0.5；95%置信区间0.4 - 0.6，p = 0.0001）以及实现病毒学抑制（aOR 0.8；95%置信区间0.6 - 0.9，p = 0.017）可预防HIV/TB合并感染。既往住院（aOR 1.2；95%置信区间1.1 - 1.4，p = 0.049）和既往结核感染（aOR 1.6；95%置信区间1.0 - 3.0，p = 0.034）与HIV/TB合并感染相关。肯尼亚东部的PLWH继续面临包括耐药菌株在内的非传染性疾病和结核病的合并流行。持续坚持ART对于实现病毒抑制至关重要；这对PLWH中的非传染性疾病和结核病具有预防作用。研究结果凸显了在肯尼亚将非传染性疾病管理与HIV和结核病治疗项目相结合的必要性。
