Abstract
Low-income and middle-income countries (LMICs) are undergoing an epidemiological transition, in which the burden of noncommunicable diseases (NCDs) is rising and mortality will shift from infectious diseases to NCDs. Specifically, cardiovascular disease, diabetes, renal diseases, chronic respiratory diseases, and cancer are becoming more prevalent. In some regions, particularly sub-Saharan Africa, the dual HIV and NCD epidemics will pose challenges because their joint burden will have adverse effects on the quality of life and will likely increase global inequities. Given the austere clinical infrastructure in many LMICs, innovative models of care delivery are needed to provide comprehensive care in resource-limited settings. Improved data collection and surveillance of NCDs among HIV-infected persons in LMICs are necessary to inform integrated NCD-HIV prevention, care, and treatment models that are effective across a range of geographic settings. These efforts will preserve the considerable investments that have been made to prevent the number of lives lost to HIV, promote healthy aging of persons living with HIV, and contribute to meeting United Nations Sustainable Development Goals.
Highlights
In high-income countries, antiretroviral therapy (ART) has improved the survival of persons living with HIV (PLHIV), resulting in declines in morbidity and mortality and a shift in the natural history of HIV disease [1,2,3]
With the success of the global effort to scale up ART access, low-income and middle-income countries (LMICs), those in sub-Saharan Africa (SSA), in which mortality has been dominated by HIV over the past decades, will start to experience syndemics
Mortality attributable to noncommunicable diseases (NCDs) will be greater than communicable diseases as it is in the rest of the world
Summary
In high-income countries, antiretroviral therapy (ART) has improved the survival of persons living with HIV (PLHIV), resulting in declines in morbidity and mortality and a shift in the natural history of HIV disease [1,2,3]. Increasing patient awareness of the effects of long-term HIV infection and effective levels of antiretroviral treatment, that is, viral suppression, the shift to a predominance of chronic diseases, is important because this improved awareness may prompt patients to report symptoms and request screening for related conditions. To understand this emerging syndemic, improved surveillance and clinical monitoring of NCDs among PLHIV are necessary to estimate the burden of and risk factors for NCDs among HIV-infected persons.
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