TY - JOUR
T1 - Association of HIV and ART with cardiometabolic traits in sub-Saharan Africa
T2 - A systematic review and meta-analysis
AU - Dillon, David G.
AU - Gurdasani, Deepti
AU - Riha, Johanna
AU - Ekoru, Kenneth
AU - Asiki, Gershim
AU - Mayanja, Billy N.
AU - Levitt, Naomi S.
AU - Crowther, Nigel J.
AU - Nyirenda, Moffat
AU - Njelekela, Marina
AU - Ramaiya, Kaushik
AU - Nyan, Ousman
AU - Adewole, Olanisun O.
AU - Anastos, Kathryn
AU - Azzoni, Livio
AU - Boom, W. Henry
AU - Compostella, Caterina
AU - Dave, Joel A.
AU - Dawood, Halima
AU - Erikstrup, Christian
AU - Fourie, Carla M.
AU - Friis, Henrik
AU - Kruger, Annamarie
AU - Idoko, John A.
AU - Longenecker, Chris T.
AU - Mbondi, Suzanne
AU - Mukaya, Japheth E.
AU - Mutimura, Eugene
AU - Ndhlovu, Chiratidzo E.
AU - Praygod, George
AU - Pefura Yone, Eric W.
AU - Pujades-Rodriguez, Mar
AU - Range, Nyagosya
AU - Sani, Mahmoud U.
AU - Schutte, Aletta E.
AU - Sliwa, Karen
AU - Tien, Phyllis C.
AU - Vorster, Este H.
AU - Walsh, Corinna
AU - Zinyama, Rutendo
AU - Mashili, Fredirick
AU - Sobngwi, Eugene
AU - Adebamowo, Clement
AU - Kamali, Anatoli
AU - Seeley, Janet
AU - Young, Elizabeth H.
AU - Smeeth, Liam
AU - Motala, Ayesha A.
AU - Kaleebu, Pontiano
AU - Sandhu, Manjinder S.
N1 - Funding Information:
This work was supported by the African Partnership for Chronic Disease Research strategic award from the UK Medical Research Council. The funders had no role in study design, data collection or analysis, decision to publish or preparation of the manuscript.
PY - 2013/12
Y1 - 2013/12
N2 - Background: Sub-Saharan Africa (SSA) has the highest burden of HIV in the world and a rising prevalence of cardiometabolic disease; however, the interrelationship between HIV, antiretroviral therapy (ART) and cardiometabolic traits is not well described in SSA populations.Methods: We conducted a systematic review and meta-analysis through MEDLINE and EMBASE (up to January 2012), as well as direct author contact. Eligible studies provided summary or individual-level data on one or more of the following traits in HIV+ and HIV-, or ART+ and ART- subgroups in SSA: body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides (TGs) and fasting blood glucose (FBG) or glycated hemoglobin (HbA1c). Information was synthesized under a random-effects model and the primary outcomes were the standardized mean differences (SMD) of the specified traits between subgroups of participants.Results: Data were obtained from 49 published and 3 unpublished studies which reported on 29 755 individuals. HIV infection was associated with higher TGs [SMD, 0.26; 95% confidence interval (CI), 0.08 to 0.44] and lower HDL (SMD, -0.59; 95% CI, -0.86 to -0.31), BMI (SMD, -0.32; 95% CI, -0.45 to -0.18), SBP (SMD, -0.40; 95% CI, -0.55 to -0.25) and DBP (SMD, -0.34; 95% CI, -0.51 to -0.17). Among HIV+ individuals, ART use was associated with higher LDL (SMD, 0.43; 95% CI, 0.14 to 0.72) and HDL (SMD, 0.39; 95% CI, 0.11 to 0.66), and lower HbA1c (SMD, -0.34; 95% CI, -0.62 to -0.06). Fully adjusted estimates from analyses of individual participant data were consistent with meta-analysis of summary estimates for most traits.Conclusions: Broadly consistent with results from populations of European descent, these results suggest differences in cardiometabolic traits between HIV-infected and uninfected individuals in SSA, which might be modified by ART use. In a region with the highest burden of HIV, it will be important to clarify these findings to reliably assess the need for monitoring and managing cardiometabolic risk in HIV-infected populations in SSA.
AB - Background: Sub-Saharan Africa (SSA) has the highest burden of HIV in the world and a rising prevalence of cardiometabolic disease; however, the interrelationship between HIV, antiretroviral therapy (ART) and cardiometabolic traits is not well described in SSA populations.Methods: We conducted a systematic review and meta-analysis through MEDLINE and EMBASE (up to January 2012), as well as direct author contact. Eligible studies provided summary or individual-level data on one or more of the following traits in HIV+ and HIV-, or ART+ and ART- subgroups in SSA: body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides (TGs) and fasting blood glucose (FBG) or glycated hemoglobin (HbA1c). Information was synthesized under a random-effects model and the primary outcomes were the standardized mean differences (SMD) of the specified traits between subgroups of participants.Results: Data were obtained from 49 published and 3 unpublished studies which reported on 29 755 individuals. HIV infection was associated with higher TGs [SMD, 0.26; 95% confidence interval (CI), 0.08 to 0.44] and lower HDL (SMD, -0.59; 95% CI, -0.86 to -0.31), BMI (SMD, -0.32; 95% CI, -0.45 to -0.18), SBP (SMD, -0.40; 95% CI, -0.55 to -0.25) and DBP (SMD, -0.34; 95% CI, -0.51 to -0.17). Among HIV+ individuals, ART use was associated with higher LDL (SMD, 0.43; 95% CI, 0.14 to 0.72) and HDL (SMD, 0.39; 95% CI, 0.11 to 0.66), and lower HbA1c (SMD, -0.34; 95% CI, -0.62 to -0.06). Fully adjusted estimates from analyses of individual participant data were consistent with meta-analysis of summary estimates for most traits.Conclusions: Broadly consistent with results from populations of European descent, these results suggest differences in cardiometabolic traits between HIV-infected and uninfected individuals in SSA, which might be modified by ART use. In a region with the highest burden of HIV, it will be important to clarify these findings to reliably assess the need for monitoring and managing cardiometabolic risk in HIV-infected populations in SSA.
KW - ART
KW - Cardiometabolic disease
KW - HIV
KW - Sub-Saharan Africa
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U2 - 10.1093/ije/dyt198
DO - 10.1093/ije/dyt198
M3 - Article
C2 - 24415610
AN - SCOPUS:84892475095
SN - 0300-5771
VL - 42
SP - 1754
EP - 1771
JO - International Journal of Epidemiology
JF - International Journal of Epidemiology
IS - 6
ER -
