Association of HIV and ART with cardiometabolic traits in sub-Saharan Africa: A systematic review and meta-analysis

David G. Dillon, Deepti Gurdasani, Johanna Riha, Kenneth Ekoru, Gershim Asiki, Billy N. Mayanja, Naomi S. Levitt, Nigel J. Crowther, Moffat Nyirenda, Marina Njelekela, Kaushik Ramaiya, Ousman Nyan, Olanisun O. Adewole, Kathryn Anastos, Livio Azzoni, W. Henry Boom, Caterina Compostella, Joel A. Dave, Halima Dawood, Christian ErikstrupCarla M. Fourie, Henrik Friis, Annamarie Kruger, John A. Idoko, Chris T. Longenecker, Suzanne Mbondi, Japheth E. Mukaya, Eugene Mutimura, Chiratidzo E. Ndhlovu, George Praygod, Eric W. Pefura Yone, Mar Pujades-Rodriguez, Nyagosya Range, Mahmoud U. Sani, Aletta E. Schutte, Karen Sliwa, Phyllis C. Tien, Este H. Vorster, Corinna Walsh, Rutendo Zinyama, Fredirick Mashili, Eugene Sobngwi, Clement Adebamowo, Anatoli Kamali, Janet Seeley, Elizabeth H. Young, Liam Smeeth, Ayesha A. Motala, Pontiano Kaleebu, Manjinder S. Sandhu

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90 Citations (Scopus)

Abstract

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(SMD) of the specified traits between subgroups of participants.Results: Data were obtained from 49 published and 3 unpublished studies which reported on 29 755 individuals.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.

Original languageEnglish (US)
Article numberdyt198
Pages (from-to)1754-1771
Number of pages18
JournalInternational Journal of Epidemiology
Volume42
Issue number6
DOIs
StatePublished - Dec 2013
Externally publishedYes

Fingerprint

Africa South of the Sahara
Meta-Analysis
HIV
Confidence Intervals
Blood Pressure
HDL Lipoproteins
Therapeutics
Body Mass Index
Population
Glycosylated Hemoglobin A
LDL Lipoproteins
MEDLINE
HIV Infections
Blood Glucose
Fasting
Triglycerides

Keywords

  • ART
  • Cardiometabolic disease
  • HIV
  • Sub-Saharan Africa

ASJC Scopus subject areas

  • Epidemiology

Cite this

Dillon, D. G., Gurdasani, D., Riha, J., Ekoru, K., Asiki, G., Mayanja, B. N., ... Sandhu, M. S. (2013). Association of HIV and ART with cardiometabolic traits in sub-Saharan Africa: A systematic review and meta-analysis. International Journal of Epidemiology, 42(6), 1754-1771. [dyt198]. https://doi.org/10.1093/ije/dyt198

Association of HIV and ART with cardiometabolic traits in sub-Saharan Africa : A systematic review and meta-analysis. / Dillon, David G.; Gurdasani, Deepti; Riha, Johanna; Ekoru, Kenneth; Asiki, Gershim; Mayanja, Billy N.; Levitt, Naomi S.; Crowther, Nigel J.; Nyirenda, Moffat; Njelekela, Marina; Ramaiya, Kaushik; Nyan, Ousman; Adewole, Olanisun O.; Anastos, Kathryn; Azzoni, Livio; Boom, W. Henry; Compostella, Caterina; Dave, Joel A.; Dawood, Halima; Erikstrup, Christian; Fourie, Carla M.; Friis, Henrik; Kruger, Annamarie; Idoko, John A.; Longenecker, Chris T.; Mbondi, Suzanne; Mukaya, Japheth E.; Mutimura, Eugene; Ndhlovu, Chiratidzo E.; Praygod, George; Pefura Yone, Eric W.; Pujades-Rodriguez, Mar; Range, Nyagosya; Sani, Mahmoud U.; Schutte, Aletta E.; Sliwa, Karen; Tien, Phyllis C.; Vorster, Este H.; Walsh, Corinna; Zinyama, Rutendo; Mashili, Fredirick; Sobngwi, Eugene; Adebamowo, Clement; Kamali, Anatoli; Seeley, Janet; Young, Elizabeth H.; Smeeth, Liam; Motala, Ayesha A.; Kaleebu, Pontiano; Sandhu, Manjinder S.

In: International Journal of Epidemiology, Vol. 42, No. 6, dyt198, 12.2013, p. 1754-1771.

Research output: Contribution to journalArticle

Dillon, DG, Gurdasani, D, Riha, J, Ekoru, K, Asiki, G, Mayanja, BN, Levitt, NS, Crowther, NJ, Nyirenda, M, Njelekela, M, Ramaiya, K, Nyan, O, Adewole, OO, Anastos, K, Azzoni, L, Boom, WH, Compostella, C, Dave, JA, Dawood, H, Erikstrup, C, Fourie, CM, Friis, H, Kruger, A, Idoko, JA, Longenecker, CT, Mbondi, S, Mukaya, JE, Mutimura, E, Ndhlovu, CE, Praygod, G, Pefura Yone, EW, Pujades-Rodriguez, M, Range, N, Sani, MU, Schutte, AE, Sliwa, K, Tien, PC, Vorster, EH, Walsh, C, Zinyama, R, Mashili, F, Sobngwi, E, Adebamowo, C, Kamali, A, Seeley, J, Young, EH, Smeeth, L, Motala, AA, Kaleebu, P & Sandhu, MS 2013, 'Association of HIV and ART with cardiometabolic traits in sub-Saharan Africa: A systematic review and meta-analysis', International Journal of Epidemiology, vol. 42, no. 6, dyt198, pp. 1754-1771. https://doi.org/10.1093/ije/dyt198
Dillon, David G. ; Gurdasani, Deepti ; Riha, Johanna ; Ekoru, Kenneth ; Asiki, Gershim ; Mayanja, Billy N. ; Levitt, Naomi S. ; Crowther, Nigel J. ; Nyirenda, Moffat ; Njelekela, Marina ; Ramaiya, Kaushik ; Nyan, Ousman ; Adewole, Olanisun O. ; Anastos, Kathryn ; Azzoni, Livio ; Boom, W. Henry ; Compostella, Caterina ; Dave, Joel A. ; Dawood, Halima ; Erikstrup, Christian ; Fourie, Carla M. ; Friis, Henrik ; Kruger, Annamarie ; Idoko, John A. ; Longenecker, Chris T. ; Mbondi, Suzanne ; Mukaya, Japheth E. ; Mutimura, Eugene ; Ndhlovu, Chiratidzo E. ; Praygod, George ; Pefura Yone, Eric W. ; Pujades-Rodriguez, Mar ; Range, Nyagosya ; Sani, Mahmoud U. ; Schutte, Aletta E. ; Sliwa, Karen ; Tien, Phyllis C. ; Vorster, Este H. ; Walsh, Corinna ; Zinyama, Rutendo ; Mashili, Fredirick ; Sobngwi, Eugene ; Adebamowo, Clement ; Kamali, Anatoli ; Seeley, Janet ; Young, Elizabeth H. ; Smeeth, Liam ; Motala, Ayesha A. ; Kaleebu, Pontiano ; Sandhu, Manjinder S. / Association of HIV and ART with cardiometabolic traits in sub-Saharan Africa : A systematic review and meta-analysis. In: International Journal of Epidemiology. 2013 ; Vol. 42, No. 6. pp. 1754-1771.
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title = "Association of HIV and ART with cardiometabolic traits in sub-Saharan Africa: A systematic review and meta-analysis",
abstract = "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.",
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author = "Dillon, {David G.} and Deepti Gurdasani and Johanna Riha and Kenneth Ekoru and Gershim Asiki and Mayanja, {Billy N.} and Levitt, {Naomi S.} and Crowther, {Nigel J.} and Moffat Nyirenda and Marina Njelekela and Kaushik Ramaiya and Ousman Nyan and Adewole, {Olanisun O.} and Kathryn Anastos and Livio Azzoni and Boom, {W. Henry} and Caterina Compostella and Dave, {Joel A.} and Halima Dawood and Christian Erikstrup and Fourie, {Carla M.} and Henrik Friis and Annamarie Kruger and Idoko, {John A.} and Longenecker, {Chris T.} and Suzanne Mbondi and Mukaya, {Japheth E.} and Eugene Mutimura and Ndhlovu, {Chiratidzo E.} and George Praygod and {Pefura Yone}, {Eric W.} and Mar Pujades-Rodriguez and Nyagosya Range and Sani, {Mahmoud U.} and Schutte, {Aletta E.} and Karen Sliwa and Tien, {Phyllis C.} and Vorster, {Este H.} and Corinna Walsh and Rutendo Zinyama and Fredirick Mashili and Eugene Sobngwi and Clement Adebamowo and Anatoli Kamali and Janet Seeley and Young, {Elizabeth H.} and Liam Smeeth and Motala, {Ayesha A.} and Pontiano Kaleebu and Sandhu, {Manjinder S.}",
year = "2013",
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doi = "10.1093/ije/dyt198",
language = "English (US)",
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journal = "International Journal of Epidemiology",
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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.

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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