Sex Differences in the Prevalence of Age-Related Hypertension and Diabetes Among Persons with HIV in West Africa Restricted; Files Only

Eckman, Jared (Spring 2024)

Permanent URL: https://etd.library.emory.edu/concern/etds/n870zs32s?locale=fr
Published

Abstract

BACKGROUND: Globally, persons with HIV are living longer and thus experiencing aging-related comorbidities such as hypertension (HTN) and type 2 diabetes (DM). While the epidemiologic burden of these conditions is well characterized in resource-rich settings, data from resource-limited settings, and on the potential for sex differences, are sparse.

METHODS: We leveraged longitudinal data from the International epidemiology Databases to Evaluate AIDS (IeDEA) in West Africa to estimate the prevalence of HTN and DM among PLWH initiating ART. Participants were followed across six HIV clinics in Burkina Faso, Côte d’Ivoire, and Nigeria from 2004-2022. HTN and DM were defined as two interval measurements of systolic and/or diastolic blood pressure >140/90 mmHg and fasting blood sugar >126 mg/dL, respectively, at most recent follow-up. PLWH without available outcomes data were excluded from respective analyses. Logistic regression models examined the effects of sex and age, and their combined effect, on each comorbidity.

RESULTS: Among 40,553 PWH (68% female), mean age was 44.6±10.6 years. The majority (74%) had virologic suppression (viral load < 200 copies/mL) and mean CD4 count was 497±315 cells/mm3. The overall prevalence of HTN and DM was 47.4% (95% CI: 46.8%, 48.0%) and 4.7% (95% CI: 4.4%, 5.0%), respectively. These rates increased with age and were significantly higher for men than women overall. When stratified by age category, men had significantly higher odds of DM compared to women in all age categories, with the greatest effect among those younger than 40. Men additionally had significantly higher odds of HTN in each age category. Sex and age were found to have a significant interaction for prevalent hypertension but not for prevalent diabetes.

CONCLUSIONS: Men living with HIV in West Africa experience a higher rate of HTN and DM compared to women living with HIV. The higher burden in men compared with women is intriguing and contrary to previous reports from higher income countries, but deserves further analysis that takes into account potential confounders. These findings highlight the need for more aggressive screening and treatment strategies for PLWH in resource limited settings, potentially differentially by sex.

 

Table of Contents

INTRODUCTION                                                                                                                                       1

HIV as a Major Threat to Public Health Worldwide                                                                                                  

Non-AIDS Comorbidities 

Aging with HIV

Sex Differences in NACM Risk

NACM Epidemiology in Sub-Saharan Africa

Specific Aims

 

METHODS                                                                                                                                                  5                                                                      

West Africa IeDEA Cohort

           Acquisition of Data

           Inclusion and Exclusion Criteria

           Study Design

           Outcome Measures

           Statistical Methods

 

RESULTS                                                                                                                                                     8

           Study Population

           Baseline Characteristics

           Prevalence of Hypertension and Diabetes

           Regression Models with HTN as Outcome

           Regression Models with DM as Outcome

 

CONCLUSIONS                                                                                                                                       15

 

DISCUSSION                                                                                                                                            16

           Strengths and Limitations

           Future Directions

 

REFERENCES                                                                                                                                          18

 

FIGURES

           Figure 1. Paradigm of NACM Burden                                                                                             3

           Figure 2. IeDEA Regional Cohorts                                                                                                  6

           Figure 3. West Africa Cohort                                                                                                           6

 

TABLES

           Table 1. Outcome Definitions                                                                                                          8

           Table 2. Distribution of Participants by Clinical Center                                                                  9

           Table 3. Baseline Characteristics of Participants                                                                           11

           Table 4. Prevalence of Hypertension and Diabetes Overall and Stratified                                     12

By Sex and Age Among West African Persons with HIV

           Table 5A. Odds of Hypertension by Sex and Age Among West African Persons with HIV        14

           Table 5B. Odds of Diabetes by Sex and Age Among West African Persons with HIV                15

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