The burden of hypertension, diabetes mellitus, and cardiovascular risk factors among adult Malawians in HIV care: consequences for integrated services.
The burden of hypertension, diabetes mellitus, and cardiovascular risk factors among adult Malawians in HIV care: consequences for integrated services.
复制标题
成年马拉维人在艾滋病毒护理中的高血压，糖尿病和心血管危险因素的负担：综合服务的后果。
DOI：
10.1186/s12889-016-3916-x
复制
发表时间：
2016-12-12
影响因子：
4.5
通讯作者：
van Oosterhout JJ
中科院分区：
文献类型：
--
作者：
Divala OH;Amberbir A;Ismail Z;Beyene T;Garone D;Pfaff C;Singano V;Akello H;Joshua M;Nyirenda MJ;Matengeni A;Berman J;Mallewa J;Chinomba GS;Kayange N;Allain TJ;Chan AK;Sodhi SK;van Oosterhout JJ
非洲人的高血压和糖尿病患病率很高。艾滋病毒感染者的数据有限，特别是来自马拉维的数据。将慢性非传染性合并症的护理纳入完善的艾滋病毒服务，可以通过防止多次住院为患者带来好处，但会增加忙碌艾滋病毒诊所的护理负担。2014年在马拉维Zomba区的一个城市和一个农村艾滋病毒诊所对成人（≥18岁）进行的横断面研究。根据严格的标准诊断高血压和糖尿病。测定蛋白尿、非空腹血脂和心/血管疾病（CVD）风险评分（Fraudine和世界卫生组织/国际高血压学会）。采用多变量分析研究了患者特征与高血压和糖尿病诊断的相关性。我们探讨了艾滋病诊所高血压和糖尿病综合药物治疗的额外护理负担。我们将这种负担定义为糖尿病和/或II期和III期高血压患者，但不包括I期高血压患者，除非他们有蛋白尿、既往卒中或高风险心血管疾病。入组952例患者，71.7%为女性，中位年龄43.0岁，95.9%接受抗逆转录病毒治疗（ART），中位持续时间47.7个月。农村和城市患者的特征有很大不同。高血压患病率为23.7%（95%置信区间为21.1-26.6;农村为21.0%，城市为26.5%; p = 0.047），其中59.9%患有I期（轻度）高血压。糖尿病患病率为4.1%（95%置信区间3.0-5.6），农村和城市之间无显著差异。蛋白尿、总/高密度脂蛋白胆固醇比值升高和高CVD风险评分的患病率较低。高血压的诊断与年龄增加、体重指数升高、蛋白尿的出现、接受齐多夫定/拉米夫定/奈韦拉平治疗有关，与ART开始时的世界卫生组织临床分期呈负相关。糖尿病的诊断与年龄较大和正在接受非标准的一线或二线抗逆转录病毒疗法有关。在接受艾滋病毒护理的患者中，26.6%患有高血压和/或糖尿病。近三分之二的高血压诊断为I期，其中少数有抗高血压药物治疗的指征。根据我们的标准，13.0%的艾滋病毒患者需要药物治疗高血压和/或糖尿病。
Hypertension and diabetes prevalence is high in Africans. Data from HIV infected populations are limited, especially from Malawi. Integrating care for chronic non-communicable co-morbidities in well-established HIV services may provide benefit for patients by preventing multiple hospital visits but will increase the burden of care for busy HIV clinics. Cross-sectional study of adults (≥18 years) at an urban and a rural HIV clinic in Zomba district, Malawi, during 2014. Hypertension and diabetes were diagnosed according to stringent criteria. Proteinuria, non-fasting lipids and cardio/cerebro-vascular disease (CVD) risk scores (Framingham and World Health Organization/International Society for Hypertension) were determined. The association of patient characteristics with diagnoses of hypertension and diabetes was studied using multivariable analyses. We explored the additional burden of care for integrated drug treatment of hypertension and diabetes in HIV clinics. We defined that burden as patients with diabetes and/or stage II and III hypertension, but not with stage I hypertension unless they had proteinuria, previous stroke or high Framingham CVD risk. Nine hundred fifty-two patients were enrolled, 71.7% female, median age 43.0 years, 95.9% on antiretroviral therapy (ART), median duration 47.7 months. Rural and urban patients’ characteristics differed substantially. Hypertension prevalence was 23.7% (95%-confidence interval 21.1–26.6; rural 21.0% vs. urban 26.5%; p = 0.047), of whom 59.9% had stage I (mild) hypertension. Diabetes prevalence was 4.1% (95%-confidence interval 3.0–5.6) without significant difference between rural and urban settings. Prevalence of proteinuria, elevated total/high-density lipoprotein-cholesterol ratio and high CVD risk score was low. Hypertension diagnosis was associated with increasing age, higher body mass index, presence of proteinuria, being on regimen zidovudine/lamivudine/nevirapine and inversely with World Health Organization clinical stage at ART initiation. Diabetes diagnosis was associated with higher age and being on non-standard first-line or second-line ART regimens. Among patients in HIV care 26.6% had hypertension and/or diabetes. Close to two-thirds of hypertension diagnoses was stage I and of those few had an indication for antihypertensive pharmacotherapy. According to our criteria, 13.0% of HIV patients in care required drug treatment for hypertension and/or diabetes.
登录
查看更多内容
影响因子：
5.7
作者：
Craig, SR;Amin, RV;Paradise, NF
通讯作者：
Paradise, NF
影响因子：
3.7
作者：
Rabkin M;Mutiti A;Chung C;Zhang Y;Wei Y;El-Sadr WM
通讯作者：
El-Sadr WM
影响因子：
3.7
作者：
Dimala, Christian Akem;Atashili, Julius;Monekosso, Gottlieb L.
通讯作者：
Monekosso, Gottlieb L.
影响因子：
1.4
作者：
Diao, Diana;Wright, James M.;Gueyffier, Francois
通讯作者：
Gueyffier, Francois
影响因子：
16.2
作者：
De Wit, Stephane;Sabin, Caroline A.;Phillips, Andrew
通讯作者：
Phillips, Andrew