Association of HIV and ART with cardiometabolic traits in sub-Saharan Africa: a systematic review and meta-analysis
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. We conducted a systematic review and m...
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| Published in | International journal of epidemiology Vol. 42; no. 6; pp. 1754 - 1771 |
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| Main Authors | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Oxford
Oxford University Press
01.12.2013
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| Subjects | |
| Online Access | Get full text |
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| Abstract | 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.
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.
Data were obtained from 49 published and 3 unpublished studies which reported on 29 755 individuals.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.
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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| AbstractList | 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.
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.
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.
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. 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. |
| Author | RIHA, Johanna ANASTOS, Kathryn AZZONI, Livio SLIWA, Karen ERIKSTRUP, Christian SEELEY, Janet TIEN, Phyllis C PRAYGOD, George VORSTER, Este H DAVE, Joel A FOURIE, Carla M COMPOSTELLA, Caterina EKORU, Kenneth CROWTHER, Nigel J IDOKO, John A NYAN, Ousman KRUGER, Annamarie MUTIMURA, Eugene SOBNGWI, Eugene KALEEBU, Pontiano ADEWOLE, Olanisun O ADEBAMOWO, Clement YOUNG, Elizabeth H SCHUTTE, Aletta E DILLON, David G MUKAYA, Japheth E MBONDI, Suzanne GURDASANI, Deepti MASHILI, Fredirick NYIRENDA, Moffat MAYANJA, Billy N DAWOOD, Halima ZINYAMA, Rutendo SMEETH, Liam RAMAIYA, Kaushik SANDHU, Manjinder S ASIKI, Gershim PUJADES-RODRIGUEZ, Mar MOTALA, Ayesha A NJELEKELA, Marina BOOM, W. Henry RANGE, Nyagosya KAMALI, Anatoli PEFURA YONE, Eric W WALSH, Corinna FRIIS, Henrik LEVITT, Naomi S SANI, Mahmoud U NDHLOVU, Chiratidzo E LONGENECKER, Chris T |
| AuthorAffiliation | 1 Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, UK, 2 Genetic Epidemiology Group, Wellcome Trust Sanger Institute, Hinxton, Cambridge, UK, 3 MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda, 4 Division of Diabetic Medicine and Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa; Chronic Diseases Initiative in Africa, 5 Department of Chemical Pathology, National Health Laboratory Service, University of the Witwatersrand Medical School, Johannesburg, South Africa, 6 Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi, 7 Department of Physiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, 8 Department of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, 9 Royal Victoria Teaching Hospital, School of Medicine, University of The Gambia, Banjul, The Gambia, 10 Department of Medicine, Obafemi A |
| AuthorAffiliation_xml | – name: 1 Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, UK, 2 Genetic Epidemiology Group, Wellcome Trust Sanger Institute, Hinxton, Cambridge, UK, 3 MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda, 4 Division of Diabetic Medicine and Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa; Chronic Diseases Initiative in Africa, 5 Department of Chemical Pathology, National Health Laboratory Service, University of the Witwatersrand Medical School, Johannesburg, South Africa, 6 Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi, 7 Department of Physiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, 8 Department of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, 9 Royal Victoria Teaching Hospital, School of Medicine, University of The Gambia, Banjul, The Gambia, 10 Department of Medicine, Obafemi Awolowo University, Ile Ife, Nigeria, 11 Women's Equity in Access to Care &Treatment, Kigali, Rwanda, 12 HIV-1 Immunopathogenesis Laboratory, Wistar Institute, Philadelphia, PA, 13 Tuberculosis Research Unit, Department of Medicine, Case Western Reserve University, Cleveland, OH, 14 Department of Medical and Surgical Sciences, University of Padua, Padua, Italy, 15 Division of Diabetic Medicine and Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa, 16 Infectious Diseases Unit, Department of Medicine, Grey's Hospital, Pietermaritzburg, South Africa, 17 Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark, 18 HART (Hypertension in Africa Research Team), North-West University, Potchefstroom, South Africa, 19 Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark, 20 Africa Unit for Transdisciplinary Health Research (AUTHeR), North-West University, Potchefstroom, South Africa, 21 Department of Medicine, Jos University Teaching Hospital, Jos, Nigeria, 22 University Hospitals Case Medical Center, Cleveland, OH, 23 German Development Cooperation (GTZ), Yaounde, Cameroon, 24 Department of Medicine, Makerere University, Kampala, Uganda, 25 Clinical Epidemiology Resource Training Centre, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe, 26 National Institute for Medical Research, Dar es Salaam, Tanzania, 27 Chest Unit of Jamot Hospital, Yaounde, Cameroon, 28 Epicentre, Médecins Sans Frontières, Paris, France, 29 Clinical Epidemiology Group, Department of Epidemiology and Public Health, University College London, London, UK, 30 Cardiology Unit, Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria, 31 Soweto Cardiovascular Research Unit, Chris Hani Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa, 32 Department of Medicine, University of California, San Francisco, CA, 33 Faculty of Health Sciences, North-West University, Potchefstroom, South Africa, 34 Department of Nutrition and Dietetics, University of the Free State, Bloemfontein, South Africa, 35 Medical Research Council of Zimbabwe, Department of Medical Laboratory Sciences, University of Zimbabwe, Harare, Zimbabwe, 36 Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon, 37 Institute of Health and Society, University of Newcastle, Newcastle, UK, 38 Institute of Human Virology, Abuja, Nigeria, 39 Department of Epidemiology and Public Health, Institute of Human Virology and Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD, 40 Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK and 41 Department of Diabetes and Endocrinology, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa |
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| BackLink | http://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=28084541$$DView record in Pascal Francis https://www.ncbi.nlm.nih.gov/pubmed/24415610$$D View this record in MEDLINE/PubMed |
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| Keywords | Immunopathology Art Disease Retroviridae Systematic review AIDS Immune deficiency Lentivirus Metaanalysis Infection Virus sub-Saharan Africa Association HIV cardiometabolic disease Viral disease Human immunodeficiency virus Public health ART |
| Language | English |
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| Snippet | Sub-Saharan Africa (SSA) has the highest burden of HIV in the world and a rising prevalence of cardiometabolic disease; however, the interrelationship between... Background Sub-Saharan Africa (SSA) has the highest burden of HIV in the world and a rising prevalence of cardiometabolic disease; however, the... |
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| SubjectTerms | Africa South of the Sahara - epidemiology Anti-HIV Agents - therapeutic use Antiretroviral Therapy, Highly Active - methods Antiretroviral Therapy, Highly Active - statistics & numerical data Biological and medical sciences Body Mass Index Diabetes Mellitus - epidemiology Dyslipidemias - epidemiology HIV Infections - drug therapy HIV Infections - epidemiology Human viral diseases Humans Hypertension - epidemiology Infectious diseases Medical sciences Miscellaneous Non-communicable Disease Risk Factors and Mortality Public health. Hygiene Public health. Hygiene-occupational medicine Viral diseases Viral diseases of the lymphoid tissue and the blood. Aids |
| Title | Association of HIV and ART with cardiometabolic traits in sub-Saharan Africa: a systematic review and meta-analysis |
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