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Association of HIV and ART with Cardiometabolic Traits in sub-Saharan Africa: A Systematic Review and Meta-Analysis.

Dillon, D. G., Gurdasani, D., Riha, J., Ekoru, K., Asiki, G., Mayanja, B. N., Levitt, N. S., Crowther, N. J., Nyirenda, M., Njelekela, M., Ramaiya, K., Nyan, O., Adewole, O. O., Anastos, K., Azzoni, L., Boom, W. H., Compostella, C., Dave, J. A., Dawood, H., Erikstrup, C., Fourie, C. M., Friis, H., Kruger, A., Idoko, J. A., Longenecker, C. T., Mbondi, S., Mukaya, J. E., Mutimura, E., Ndhlovu, C. E., Praygod, G., Pefura Yone, E. W., Pujades-Rodriguez, M., Range, N., Sani, M. U., Schutte, A. E., Sliwa, K., Tien, P. C., Vorster, E. H., Walsh, C., Zinyama, R., Mashili, F., Sobngwi, E., Adebamowo, C., Kamali, A., Seeley, J., Young, E. H., Smeeth, L., Motala, A. A., Kaleebu, P. and 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). pp. 1754-71. ISSN 1464-3685

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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 Data were obtained from 49 published and 3 unpublished studies which reported on 29 755 individuals.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.

Item Type: Article
Keywords: ART, HIV, Cardiometabolic Disease, sub-Saharan Africa
Subjects: HIV > Treatment
Divisions: Muhimbili University of Health and Allied Sciences (MUHAS)
Depositing User: Mr Joseph Madata
Date Deposited: 27 Jun 2016 06:01
Last Modified: 27 Jun 2016 06:01

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