Abstract
BackgroundAntiretroviral treatment (ART) has been associated with the development of certain cardiometabolic diseases (CMDs). The burden of CMDs amongst ART-experienced patients in sub-Saharan Africa was unknown.ObjectiveWe quantified the burden of CMDs and identified the associated risk factors in a large treatment cohort on ART at a high-volume facility in Lesotho.MethodsIn this retrospective cohort study, we extracted data from the daily dispensing electronic system and routine clinical records of 785 adults on ART between 2011 and 2015 in Maseru, Lesotho. CMD was defined as a diagnosis of hypertension, diabetes mellitus or dyslipidaemia (singly or collectively). Descriptive statistics were used to describe the disease burden; Kaplan–Meier curves and cause-specific Cox proportional hazards models were fitted to examine the impact of the ART regimen and identify the risk factors associated with the occurrence of CMD.ResultsOf the 785 participants, 473 (60%) were women. The median age of the group was 42 years, interquartile range (IQR), 36–51 years. The overall incidence of CMD was 5.6 (95% confidence interval [CI] = 4.4–7.1) per 100 person-months of follow-up. The median time to onset of CMD was 16.6 months (IQR = 7.4–23.4). ART was not associated with the occurrence of CMD (cause-specific hazard ratio [CHR] = 1.55; 95% CI = 0.14–16.85; P = 0.72). Higher body mass index (BMI) was associated with the occurrence of diabetes mellitus (CHR = 1.19; 95% CI = 1.14–1.38; P = 0.026).ConclusionThe incidence of CMD in this relatively young patient population is low yet noteworthy. We recommend that patients living with HIV and AIDS should be routinely screened for CMD. Higher BMI is generally associated with the occurrence of CMD.
Highlights
Sub-Saharan Africa (SSA) currently has the largest burden of HIV infection in the world and 69.65% of people living with HIV (PLWH) were reported to be on antiretroviral treatment (ART) in 2019.1 The countries with the highest burden of HIV include Swaziland, Botswana and Lesotho, with approximately 25% of the general population infected.[2]
The participants were stratified according to their current ART regimen (NNRTIbased regimen: 98.1%, n = 770; protease inhibitors (PIs)-based regimen: 1.9%, n = 15)
Our findings provide valuable baseline information about the influence of ART on the incidence of cardiometabolic diseases (CMDs) in PLWH in Africa, especially Lesotho, which has the second-highest prevalence of HIV after Eswatini.[2,27,28,29]
Summary
Sub-Saharan Africa (SSA) currently has the largest burden of HIV infection in the world and 69.65% of people living with HIV (PLWH) were reported to be on antiretroviral treatment (ART) in 2019.1 The countries with the highest burden of HIV include Swaziland, Botswana and Lesotho, with approximately 25% of the general population infected.[2]. Since the introduction of ART, the survival and life expectancy of PLWH have been enhanced, with approximately 19.1 million life-years being saved from 1990 to 2013.4,5. Prolonged exposure to ART, in addition to aging because of improved life expectancy, is associated with a higher risk of cardiometabolic diseases (CMDs), which include dyslipidaemia, obesity, hyperglycaemia (diabetes mellitus) and hypertension. Since the introduction of ART, approximately 4 million PLWH have survived beyond 50 years of age.[8] http://www.sajhivmed.org.za Open Access. Despite good management and control, elderly patients on ART have a higher risk of CMDs (which tends to appear approximately 10 years earlier than in HIV-uninfected individuals) compared to their counterparts in the general population, because of interactions between the natural risk factors that develop with aging and the effects of ART and HIV. The burden of CMDs amongst ART-experienced patients in sub-Saharan Africa was unknown
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