Noncommunicable disease burden among HIV patients in care: a national retrospective longitudinal analysis of HIV-treatment outcomes in Kenya, 2003-2013
Noncommunicable disease burden among HIV patients in care: a national retrospective longitudinal analysis of HIV-treatment outcomes in Kenya, 2003-2013
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DOI：
10.1186/s12889-019-6716-2
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发表时间：
2019-04-03
影响因子：
4.5
通讯作者：
De Cock, Kevin M.
中科院分区：
文献类型：
--
作者：
Achwoka, Dunstan;Waruru, Anthony;De Cock, Kevin M.
背景：在过去的十年中，肯尼亚的艾滋病毒治疗方案呈指数级增长，艾滋病毒携带者(PLHIV)的存活率有所提高。在同一时期，非传染性疾病已成为疾病负担的主要贡献者。方法：我们对2003年10月1日至2013年9月30日在肯尼亚登记的15岁艾滋病毒感染者进行了一项具有全国代表性的回顾病历。我们在加入HIV护理时和随后的HIV护理访问中估计了四种非传染性疾病类别在PLHIV中的比例。我们用卡方检验比较了合并症的比例并评估了其分布。结果：我们分析了3170例HIV感染者的病历，其中2115例(66.3%)来自女性。略高于一半(51.1%)的患者记录来自35岁以上的PLHIV。近三分之二(63.9%)的PLHIV接受抗逆转录病毒治疗。在确诊为NCD的PLHIV中，高血压是最常见的NCD343例(87.5%)。尽管如此，只有17名患者(4.9%)在他们的病历中有相应的高血压诊断文件。男性和女性NCD总发病率分别为42.3/1000人年[95%可信区间35.8，50.1]和31.6[95%可信区间27.7，36.1]。与女性相比，男性罹患非传染性疾病的发病率比为1.3[95%可信区间1.1，1.7]，p=0.0082。婚姻或就业状况对非传染性疾病发病率没有影响。在随访一年时，43.8%的非抗逆转录病毒治疗患者被诊断为非传染性疾病，而接受抗逆转录病毒治疗的患者中诊断为非传染性疾病的比例为3.7%；五年后诊断为非传染性疾病的比例分别为88.8%和39.2%(p<；0.001)。在缺乏系统、有效的筛查的情况下，非传染性疾病在这一人群中的负担可能被低估。应将使用标准指南对非传染性疾病进行系统的筛查和治疗纳入撒哈拉以南非洲的艾滋病毒护理和治疗计划。
Background: Over the last decade, the Kenyan HIV treatment program has grown exponentially, with improved survival among people living with HIV (PLHIV). In the same period, noncommunicable diseases (NCDs) have become a leading contributor to disease burden. We sought to characterize the burden of four major NCDs (cardiovascular diseases, cancer, chronic respiratory diseases and diabetes mellitus) among adult PLHIV in Kenya.Methods: We conducted a nationally representative retrospective medical chart review of HIV-infected adults aged 15 years enrolled in HIV care in Kenya from October 1, 2003 through September 30, 2013. We estimated proportions of four NCD categories among PLHIV at enrollment into HIV care, and during subsequent HIV care visits. We compared proportions and assessed distributions of co-morbidities using the Chi-Square test. We calculated NCD incidence rates and their confidence intervals in assessing cofactors for developing NCDs.Results: We analyzed 3170 records of HIV-infected patients; 2115 (66.3%) were from women. Slightly over half (51.1%) of patient records were from PLHIVs aged above 35 years. Close to two-thirds (63.9%) of PLHIVs were on ART. Proportion of any documented NCD among PLHIV was 11.5% (95% confidence interval [CI] 9.3, 14.1), with elevated blood pressure as the most common NCD 343 (87.5%) among PLHIV with a diagnosed NCD. Despite this observation, only 17 (4.9%) patients had a corresponding documented diagnosis of hypertension in their medical record. Overall NCD incidence rates for men and women were (42.3 per 1000 person years [95% CI 35.8, 50.1] and 31.6 [95% CI 27.7, 36.1], respectively. Compared to women, the incidence rate ratio for men developing an NCD was 1.3 [95% CI 1.1, 1.7], p = 0.0082). No differences in NCD incidence rates were seen by marital or employment status. At one year of follow up 43.8% of PLHIV not on ART had been diagnosed with an NCD compared to 3.7% of patients on ART; at five years the proportions with a diagnosed NCD were 88.8 and 39.2% (p < 0.001), respectively.Conclusions: PLHIV in Kenya have a high prevalence of NCD diagnoses. In the absence of systematic, effective screening, NCD burden is likely underestimated in this population. Systematic screening and treatment for NCDs using standard guidelines should be integrated into HIV care and treatment programs in sub-Saharan Africa.