Association of HIV and ART with cardiometabolic traits in sub-Saharan Africa: a systematic review and meta-analysis
Year: 2013
Type: review
Study designs: Systematic Review, 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 RESULTS: Data were obtained from 49 published and 3 unpublished studies which reported on 29 755 individuals.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.
DOI: 10.1093/ije/dyt198
Authors: 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 Erikstrup, Carla 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
Institutions: National Health Laboratory Service, University of Cape Town, University of the Witwatersrand, University of Cambridge, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Wellcome Sanger Institute, MRC/UVRI & LSHTM Uganda Research Unit, Uganda Virus Research Institute, University of Liverpool, Muhimbili University of Health and Allied Sciences, Edward Francis Small Teaching Hospital, Obafemi Awolowo University, University of Global Health Equity, British HIV Association, Case Western Reserve University, University of Padua, Grey's Hospital, Aarhus University Hospital, North-West University, University of Copenhagen, University College Copenhagen, Jos University Teaching Hospital, University Hospitals Cleveland Medical Center, Deutsche Gesellschaft für Internationale Zusammenarbeit, Makerere University, University of Zimbabwe, National Institute for Medical Research, University College London, Aminu Kano Teaching Hospital, Chris Hani Baragwanath Hospital, University of California, San Francisco, University of the Free State, University of Maryland, Baltimore
Language: English
Subfield: Emergency Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
Awards: Malawi-Liverpool-Welcome Trust Clinical Research Programme., Exploiting the potential offered by the increasing computerisation of health records for population based research., Malawi Centre for Research in Epidemiology and Public Health: addressing public health research priorities through partnership., NIHR Senior Investigator Award, Wellcome Trust - Cambridge Centre for Global Health Research, G7129414704
OpenAlex ID: W2105905549