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Moyo-Chilufya M, Maluleke K, Kgarosi K, Muyoyeta M, Hongoro C, Musekiwa A. The burden of non-communicable diseases among people living with HIV in Sub-Saharan Africa: a systematic review and meta-analysis. EClinicalMedicine 2023; 65:102255. [PMID: 37842552 PMCID: PMC10570719 DOI: 10.1016/j.eclinm.2023.102255] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 09/18/2023] [Accepted: 09/18/2023] [Indexed: 10/17/2023] Open
Abstract
Background Non-communicable diseases (NCDs) are increasing among people living with HIV (PLHIV), especially in Sub-Saharan Africa (SSA). We determined the prevalence of NCDs and NCD risk factors among PLHIV in SSA to inform health policy makers. Methods We conducted a systematic review and meta-analysis on the prevalence of NCDs and risk factors among PLHIV in SSA. We comprehensively searched PubMed/MEDLINE, Scopus, and EBSCOhost (CINAHL) electronic databases for sources published from 2010 to July 2023. We applied the random effects meta-analysis model to pool the results using STATA. The systematic review protocol was registered on PROSPERO (registration number: CRD42021258769). Findings We included 188 studies from 21 countries in this meta-analysis. Our findings indicate pooled prevalence estimates for hypertension (20.1% [95% CI:17.5-22.7]), depression (30.4% [25.3-35.4]), diabetes (5.4% [4.4-6.4]), cervical cancer (1.5% [0.1-2.9]), chronic respiratory diseases (7.1% [4.0-10.3]), overweight/obesity (32.2% [29.7-34.7]), hypercholesterolemia (21.3% [16.6-26.0]), metabolic syndrome (23.9% [19.5-28.7]), alcohol consumption (21.3% [17.9-24.6]), and smoking (6.4% [5.2-7.7]). Interpretation People living with HIV have a high prevalence of NCDs and their risk factors including hypertension, depression, overweight/obesity, hypercholesterolemia, metabolic syndrome and alcohol consumption. We recommend strengthening of health systems to allow for improved integration of NCDs and HIV services in public health facilities in SSA. NCD risk factors such as obesity, hypercholesterolemia, and alcohol consumption can be addressed through health promotion campaigns. There is a need for further research on the burden of NCDs among PLHIV in most of SSA. Funding This study did not receive any funding.
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Affiliation(s)
- Maureen Moyo-Chilufya
- Faculty of Health Sciences, School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Kuhlula Maluleke
- Faculty of Health Sciences, School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Kabelo Kgarosi
- Faculty of Health Sciences, School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Monde Muyoyeta
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Charles Hongoro
- Faculty of Health Sciences, School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
- Human Sciences Research Council, Pretoria, South Africa
| | - Alfred Musekiwa
- Faculty of Health Sciences, School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
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Hema A, Poda A, Tougouma JB, Meda C, Kabore F, Zoungrana J, Kamoule E, Sore I, Bado G, Ouedraogo AS, Sawadogo AB, Millogo A. [Diabetes mellitus and high blood pressure over risk in HIV-infected people followed at Souro Sanou University Hospital Day Hospital, Bobo-Dioulasso 2018]. Rev Epidemiol Sante Publique 2021; 69:72-77. [PMID: 33563493 DOI: 10.1016/j.respe.2020.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 11/24/2020] [Accepted: 12/10/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Non-communicable diseases (NCDs) represent the leading causes of death worldwide. HIV also increases the risk of developing NCDs including diabetes mellitus and hypertension. METHODS A cross-sectional study, based on an analysis of the cohort database of the day hospital of the Souro Sanou teaching hospital in Bobo-Dioulasso (Burkina Faso). Diabetes mellitus was defined by the undergoing of anti-diabetic treatment or two successive measurements of fasting blood sugar above 7mmol/l and high blood pressure by the undergoing of antihypertensive treatment or two successive measurements of blood pressure above 140/90mmHg. Comparison of the frequency of diabetes and hypertension in the people living with HIV/AIDS (PLWHA) population on antiretroviral therapy (ART) with that of the general population of Burkina Faso was made by indirect standardization according to age and gender. RESULTS A total of 4259 patients including 3148 women (73.9%) were included in this study. The median age of the patients was 45 years (IQR: 38-52); the median body mass index (BMI) was 19.6kg/m2 (IQR: 15.4 - 22.7) and 48.3% of patients had a BMI≥25kg/m2. The median CD4 count was 590 cells/mm3 (IQR: 417-785). The median ART duration was 8.2 years (IQR: 4.7-11.2). The majority of patients (82.9%) were on treatment combinations consisting in 2 INTI+1 NNRTI. Prevalence of hypertension was 39.8%; it was statistically higher in men than in women (45.8% versus 37.8%). Prevalence of hypertension was 87.0% higher in the PLWHA population than among same-sex and same-age subjects in the general population. Prevalence of diabetes mellitus was 7.3%. Diabetes mellitus was more common in men than in women (10.1% versus 6.3%; P<10-3). Prevalence of diabetes mellitus was 36.0% higher in the PLWHA population than among same-sex and same-age subjects in the general population. CONCLUSION Prevalence of diabetes mellitus and hypertension was higher among PLHWA undergoing ART than in the general population. Care for the PLHWA population should more widely include NCD treatment.
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Affiliation(s)
- A Hema
- Hôpital de jour du service de maladies infectieuses, CHU Souro Sanou, 01 BP 676, Bobo-Dioulasso, Burkina Faso.
| | - A Poda
- Hôpital de jour du service de maladies infectieuses, CHU Souro Sanou, 01 BP 676, Bobo-Dioulasso, Burkina Faso; Institut national des sciences de la santé, Université Nazi Boni, Bobo-Dioulasso, Burkina Faso
| | - J-B Tougouma
- Service de cardiologie, CHU Souro Sanou, 01 BP 676, Bobo-Dioulasso, Burkina Faso; Institut national des sciences de la santé, Université Nazi Boni, Bobo-Dioulasso, Burkina Faso
| | - C Meda
- Institut national des sciences de la santé, Université Nazi Boni, Bobo-Dioulasso, Burkina Faso
| | - F Kabore
- Institut national de santé publique, Ouagadougou, Burkina Faso
| | - J Zoungrana
- Hôpital de jour du service de maladies infectieuses, CHU Souro Sanou, 01 BP 676, Bobo-Dioulasso, Burkina Faso; Institut national des sciences de la santé, Université Nazi Boni, Bobo-Dioulasso, Burkina Faso
| | - E Kamoule
- Service d'hépato-gastroentérologie, CHU Souro Sanou, 01 BP 676, Bobo-Dioulasso, Burkina Faso
| | - I Sore
- Hôpital de jour du service de maladies infectieuses, CHU Souro Sanou, 01 BP 676, Bobo-Dioulasso, Burkina Faso
| | - G Bado
- Hôpital de jour du service de maladies infectieuses, CHU Souro Sanou, 01 BP 676, Bobo-Dioulasso, Burkina Faso
| | - A-S Ouedraogo
- Hôpital de jour du service de maladies infectieuses, CHU Souro Sanou, 01 BP 676, Bobo-Dioulasso, Burkina Faso
| | - A-B Sawadogo
- Hôpital de jour du service de maladies infectieuses, CHU Souro Sanou, 01 BP 676, Bobo-Dioulasso, Burkina Faso
| | - A Millogo
- UFR/Sciences de la santé, Université Joseph Ki Zerbo, Ouagadougou, Burkina Faso
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Masenga SK, Hamooya BM, Nzala S, Kwenda G, Heimburger DC, Mutale W, Munsaka SM, Koethe JR, Kirabo A. Patho-immune Mechanisms of Hypertension in HIV: a Systematic and Thematic Review. Curr Hypertens Rep 2019; 21:56. [PMID: 31165257 PMCID: PMC6548744 DOI: 10.1007/s11906-019-0956-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW To systematically review recent findings on the role of immune cell activation in the pathogenesis of hypertension in people living with HIV (PLWH) and compare studies from Sub-Saharan Africa with what is reported in the USA and European literature according to guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. RECENT FINDINGS PLWH have an increased risk for development of hypertension and cardiovascular disease. Chronic immune activation contributes to hypertension but the inflammatory milieu that predisposes PLWH to hypertension is poorly understood. We identified 45 relevant studies from 13 unique African countries. The prevalence of hypertension in PLWH on antiretroviral therapy (ART) and the ART-naive PLWH ranged from 6 to 50% and 2 to 41%, respectively. Interleukin (IL)-17A, interferon (IFN)-γ, and higher CD4+ T cell counts were associated with hypertension in ART-treated participants. Targeting adaptive immune activation could provide improved care for hypertensive PLWH. Further research is needed to characterize the inflammatory milieu contributing to hypertension in PLWH especially in African populations where the global burden of HIV is the highest.
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Affiliation(s)
- Sepiso K. Masenga
- School of Medicine and Health Sciences, Mulungushi University, Livingstone, Zambia
- School of Health Sciences, Department of Biomedical Sciences, University of Zambia, Lusaka, Zambia
- Vanderbilt Institute for Global Health, Nashville, TN USA
| | - Benson M. Hamooya
- School of Medicine and Health Sciences, Mulungushi University, Livingstone, Zambia
- School of Public Health, Department of Epidemiology and Biostatistics, University of Zambia, Lusaka, Zambia
| | - Selestine Nzala
- Department of Medical Education Development, University of Zambia, Lusaka, Zambia
| | - Geoffrey Kwenda
- School of Health Sciences, Department of Biomedical Sciences, University of Zambia, Lusaka, Zambia
| | | | - Wilbroad Mutale
- School of Public Health, Department of Health policy and Management, University of Zambia, Lusaka, Zambia
| | - Sody M. Munsaka
- School of Health Sciences, Department of Biomedical Sciences, University of Zambia, Lusaka, Zambia
| | - John R. Koethe
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN USA
| | - Annet Kirabo
- Department of Medicine, Division of Clinical Pharmacology, Vanderbilt University Medical Center, 2215 Garland Avenue, P415C Medical Research Building IV, Nashville, TN 37232 USA
- Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, TN USA
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Mawaw PM, Yav T, Mukuku O, Lukanka O, Kazadi PM, Tambwe D, Omba J, Kakoma JB, Bangs MJ, Luboya ON. Prevalence of obesity, diabetes mellitus, hypertension and associated risk factors in a mining workforce, Democratic Republic of Congo. Pan Afr Med J 2017; 28:282. [PMID: 29942414 PMCID: PMC6011003 DOI: 10.11604/pamj.2017.28.282.14361] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 11/22/2017] [Indexed: 02/05/2023] Open
Abstract
Introduction The burden of non-communicable diseases (NCDs) is increasing in low and middle-income countries (LMIC). According to the World Health Organization (WHO) the largest increase occurs in Africa. Obesity, diabetes mellitus and hypertension (ODH) are major risk factors for cardiovascular diseases, causing nearly 18 million deaths worldwide. Various risks associated with mining as an occupational activity are implicated in NCDs' occurrence. This study describes the baseline prevalence of ODH and associated risk factors in the workforce of Tenke Fungurume Mining (TFM), in southern Democratic Republic of Congo. Methods A cross-sectional study was conducted on a sample of 2,749 employees' and contractor's occupational health examination files for 2010. Socio-demographic, occupational, medical, anthropometric and behavioral characteristics were collected and assessed. Disease status regards ODH was based on WHO criteria. A multivariate logistic regression model was used. Results Overall prevalence of ODH was 4.5%, 11.7%, and 18.2% respectively. Proportions of pre-ODH individuals were 19.7%, 16.5%, and 47.8% respectively. Prevalence of ODH increased with age, professional grade, nature of work, gender and reported alcohol use. Smoking 10 or more cigarettes per day increased risk of diabetes and hypertension, while decreasing obesity. Conclusion Rates of ODH and associated risk factors are higher in the TFM workforce, than in the general DRC population. This is likely reflective of other mining sites in the country and region. It is evident that ODH are associated with various socio-demographic, occupational, anthropometric, biomedical and behavioral risk factors. A NCD prevention program and close monitoring of disease and risk factors trends are needed in this population.
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Affiliation(s)
- Paul Makan Mawaw
- Department of Public Health, University of Lubumbashi, Democratic Republic of Congo
| | - Thierry Yav
- Department of Public Health, University of Lubumbashi, Democratic Republic of Congo
| | - Olivier Mukuku
- Department of Research, High School for Medical Technics of Lubumbashi, Democratic Republic of Congo
| | - Olivier Lukanka
- Department of Public Health, University of Lubumbashi, Democratic Republic of Congo
| | - Patrick Mumba Kazadi
- Occupational Health Clinic, International SOS Tenke Fungurume Mine, Democratic Republic of Congo
| | - Daniel Tambwe
- International SOS Clinic, Kinshasa, Democratic Republic of Congo
| | - Jules Omba
- Anglo-Gold Ashanti, Mongbwalu Clinic, Democratic Republic of Congo
| | - Jean-Baptiste Kakoma
- Department of Gynecology and Obstetrics, University of Lubumbashi, Democratic Republic of Congo
| | - Michael John Bangs
- Freeport/International SOS Public Health and Malaria Control, Kuala Kencana, Papua, Indonesia
| | - Oscar Numbi Luboya
- Department of Public Health, University of Lubumbashi, Democratic Republic of Congo
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