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)
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
About this Master's Thesis
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File download under embargo until 22 November 2024 | 2024-04-04 12:09:48 -0400 | File download under embargo until 22 November 2024 |
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