Prevalence and characteristics of metabolic syndrome and its components among adults living with and without HIV in Nigeria: a single-center study

BACKGROUND

Persons living with HIV (PLHIV) now live longer due to effective combination antiretroviral therapy. However, emerging evidence indicates that they may be at increased risk for some cardiometabolic disorders. We compared the prevalence of metabolic syndrome (MetS) and its component disorders between persons living with and without HIV in Nigeria.

METHODS

This was a cross-sectional analysis of baseline data from a prospective cohort study of non-communicable diseases among PLHIV along with age- and sex-matched persons without HIV (PWoH) at the University of Abuja Teaching Hospital Nigeria. We collected sociodemographic and clinical data, including anthropometric measures and results of relevant laboratory tests. MetS was defined using a modification of the third report of the National Cholesterol Education Program Adult Treatment Panel (NCEP ATP III) criteria.

RESULTS

Of the 440 PLHIV and 232 PWoH, women constituted 50.5% and 51.3% respectively. The median age of the PLHIV was 45 years while that of the PWoH was 40 years. The prevalence of MetS was 30.7% (95% CI: 26.4%, 35.2%) and 22.8% (95% CI: 17.6%, 28.8%) among the PLHIV and PWoH respectively (P = 0.026). Independent associations were found for older age (P < 0.001), female sex (P < 0.001), family history of diabetes (P < 0.001), family history of hypertension (P = 0.013) and alcohol use (P = 0.015). The prevalence of component disorders for PLHIV versus PWoH were as follows: high blood pressure (22.3% vs 20.3%), prediabetes (33.8% vs 21.1%), diabetes (20.5% vs 8.2%), high triglycerides (24.5% vs 17.2%), low HDL-Cholesterol (51.1% vs 41.4%), and abdominal obesity (38.4% vs 37.1%). Adjusting for age and sex, prediabetes, diabetes, and low HDL-Cholesterol were significantly associated with HIV status. Duration on antiretroviral therapy, protease inhibitor-based regimen, CD4 count, and viral load were associated with some of the disorders mostly in unadjusted analyses.

CONCLUSION

We found a high burden of MetS and its component disorders, with significantly higher prevalence of dysglycemia and dyslipidemia among PLHIV as compared to PWoH. Integration of strategies for the prevention and management of MetS disorders is needed in HIV treatment settings.

Prevalence and Risk Factors for Mycobacterium tuberculosis Infection among Health Workers in HIV Treatment Centers in North Central, Nigeria

Mycobacterium tuberculosis and HIV constitute a public health challenge. Health workers (HWs) in HIV clinics maybe at greater risk of M. tuberculosis infection, considering the high rates of HIV/tuberculosis (TB) coinfection among patients. Hence, we measured the prevalence of M. tuberculosis infection and the effect of working in an HIV clinic. We conducted a cross-sectional study in high-HIV burden health-care facilities in Abuja and Nasarawa states and recruited HWs over 4 months. We administered questionnaires and screened for M. tuberculosis infection using QuantiFERON-TB Gold-Plus. A total of 1,043 HWs were enrolled, with the majority being clinical staff (77.4%). Prevalence of interferon gamma release assay (IGRA) positivity was 44.8% (43.8% among HWs from HIV clinic and 45.3% from non-HIV clinics, P = 0.24). Nonoccupational factors such as living in a moderately (odds ratio [OR] = 0.71] or sparsely populated neighborhood (OR = 0.56), remained associated with a reduced risk of IGRA positivity, whereas male gender (OR = 1.37) and having high blood pressure (HBP) (OR = 1.52) remained associated with an increased risk after adjusting. Occupational factors such as length of career as a HW of 10 to 20 years (OR = 1.45) or 20 to 30 years (OR = 1.74) remained associated with an increased risk of IGRA positivity after adjusting. In a final multivariate model, the factors of age between 20 to < 30 years (OR = 0.61), having HBP (OR = 1.56), having a length of career as a HW of 10 to 20 years (OR = 1.66) or 20 to 30 years (OR = 2.09) and being a clinical HW (OR = 0.62) remained associated with IGRA positivity. There is a high prevalence of IGRA positivity among HWs in Nigeria. Working in HIV clinics, however, is not associated with increased risk.

HIV-associated high-risk HPV infection in Nigerian women

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Background: The incidence of cervical cancer has remained stable in HIV+ women but the prevalence and multiplicity of high risk HPV (hrHPV) infection, a necessary cause of cervical cancer, appears different comparing HIV+ to HIV- women. Because this has not been well studied in Africa, we conducted this study to identify single and multiple hrHPV infection among HIV+ and HIV- women in Nigeria. Methods: We enrolled HIV+ and HIV- women presenting at our cervical cancer screening program in Abuja, Nigeria between April 2012 and August 2012. Using a nurse administered questionnaire, we collected information on demographic characteristics, risk factors of HPV infection and cervical exfoliated cells samples from all participants. We used Roche Linear Array HPV Genotyping Test to characterize the prevalent HPV according to manufacturer’s instruction and logistic regression models to estimate the association between HIV infection and the risk of high-risk HPV infection. Results: There were 278 participants, 40% (111) of whom were HIV negative, 54% (151) HIV positive and 6% (16) with HIV status unknown. Of these, 108 HIV+ women cases and 149 HIV- women controls were available for analysis. The mean ages (±SD) were 37.6 (±7.7) for HIV+ and 36.6 (±7.9) years for HIV- women (p-value = 0.34). Cases and controls had similar socio-demographic characteristics. Among HIV+ women, HPV35 (8.7%) and HPV56 (7.4%) were the most prevalent hrHPV, while HPV52 and HPV68 (2.8%, each) were the most prevalent among HIV- women. The age adjusted RR for prevalent hrHPV was 4.18 (95% CI 2.05 – 8.49, p-value <0.0001), comparing HIV+ to HIV- women. The multivariate RR for any HPV and multiple hrHPV was 3.75 (95% CI 2.08 – 6.73, p-value 0.01) and 6.6 (95% CI 1.49 – 29.64, p-value 0.01) respectively, comparing HIV+ to HIV- women, adjusted for age, and educational level. Conclusions: HIV infection was associated with increased risk of any HPV, hrHPV and multiple HPV infections. Oncogenic HPV types 35, 52, 56 and 68 may be more important risk factors for cervical pre-cancer and cancer among women in Africa. Polyvalent hrHPV vaccines meant for African populations should protect against HPV types other than 16 and 18.

Abstract 2588: Increased risk of prevalent high risk human papillomavirus infection in Lactobacillus iners rich microbiota in Nigerian women

The microbiota plays an important role in prevention of colonization of the vagina by pathogenic organisms such as HIV, Herpes simplex virus and N. gonorrhea. Given the role of persistent high risk HPV (hrHPV) infection of the cervix as a necessary but not sufficient cause of cervical, we hypothesized that in addition to other risk factors, specific community types of vaginal microbiota may be cofactors in the etiology of cervical cancer and pre-cancer (CIN2+).

We enrolled HIV+ and HIV- women who presented to our cervical cancer screening program at the National Hospital, Abuja and the University of Abuja Teaching Hospital, Abuja, Nigeria between April and August 2012 into this study. Using a nurse administered questionnaire, we collected information on demographics and risk factors of cervical cancer. Without cleaning the introitus, we collected mid-vaginal samples and cervical exfoliated cells from all participants.

We characterized the vaginal microbiota from the mid-vaginal sample by using barcoded universal primers 515F and 806R for the amplification of the V3 - V5 hypervariable regions of 16s rRNA gene and sequenced on an Illumina MiSeq Instrument. The processed gene sequences were classified using the RDP Naïve Bayesian Classifier and the vaginal microbiota were clustered into community state types (CST) according to community composition. We used Roche Linear Array HPV Genotyping Test® to characterize the prevalent HPV according to manufacturer's instruction. We analyzed association between community class types of vaginal microbiota and hrHPV infection using Fisher's exact tests.

We enrolled 278 women, 40% (111) of whom were HIV negative, 54% (151) HIV positive and 6% (16) with HIV status unknown. The prevalence of hrHPV types among the HIV- women was 10.6%, and 35.6% among the HIV+ women. hrHPV infection was commoner among HIV positive compared to HIV negative participants (OR 4.67, 95%CI 2.32 - 9.88, p&lt;0.0001). The commonest clusters of vaginal microbiota CSTs that we identified in our sample were - Lactobacillus iners rich CST III and CST IV which lacked significant numbers of Lactobacillus. Amongst the HIV negative enrollees, participants with CST III were more likely to test positive for prevalent hrHPV than participants with CST IV (OR 3.6, 95% CI: 0.88 - 16.96, p = 0.05). Amongst the HIV positive participants, the presence of CST III was commoner among women with prevalent hrHPV but this was not statistically significant (OR 1.14, 95% CI 0.55 - 2.40, p=0.73)

Our results suggest that L.iners rich microbiota may be associated with increased risk of prevalent hrHPV infection in Nigerian women. Further research is needed to confirm this preliminary result and to evaluate the relationship of vaginal microbiota with persistent hrHPV infection.

This work was supported by the UM-Capacity Development for Research in AIDS Associated Malignancy Grant (NIH/NCI 1D43CA153792-01)

Citation Format: Eileen O. Dareng, Ayo O. Famooto, Celestine C. Ogbonna, Sally Akarolo-Anthony, Maryam Al-Mujtaba, George Odonye, Olayinka B. Olaniyan, Richard Offiong, Ishak Lawal, Pawel Gajer, Doug Fadrosh, Honqui Yang, Jacques Ravel, Clement Adebamowo. Increased risk of prevalent high risk human papillomavirus infection in Lactobacillus iners rich microbiota in Nigerian women. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 2588. doi:10.1158/1538-7445.AM2013-2588

Pattern of dietary carbohydrate intake among urbanized adult Nigerians

As the nutrition transition continues in Africa, it is crucial to identify population-specific dietary patterns. Healthy diets may then be promoted for prevention and alleviation of the chronic disease burden associated with nutrition. Using a semi-quantitate food frequency questionnaire, we conducted a cross-sectional study and computed the proportions of foods commonly consumed, and collected data on anthropometric characteristics. The median total energy intake per day from these carbohydrate sources was 1034 kcal (interquartile range (IOR) 621.5-1738.6 kcal). The main carbohydrate food eaten was rice (48.6%) followed by fufu (30.5%) and bread (13.1%). The prevalence of overweight and obesity was 63%, and 73% of the women in the study were either overweight or obese compared to 56% of men. Our study showed that parboiled long grain white rice is now the most commonly consumed carbohydrate by urbanized Nigerians. Other traditional carbohydrate foods are still consumed frequently and remain quite popular.