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Association of HIV and ART with cardiometabolic traits in sub-Saharan Africa: a systematic review and meta-analysis.
- Gurdasani, Deepti;
- Riha, Johanna;
- Ekoru, Kenneth;
- Asiki, Gershim;
- Mayanja, Billy;
- Levitt, Naomi;
- Crowther, Nigel;
- Nyirenda, Moffat;
- Njelekela, Marina;
- Ramaiya, Kaushik;
- Nyan, Ousman;
- Adewole, Olanisun;
- Anastos, Kathryn;
- Azzoni, Livio;
- Boom, W;
- Compostella, Caterina;
- Dave, Joel;
- Dawood, Halima;
- Erikstrup, Christian;
- Fourie, Carla;
- Friis, Henrik;
- Kruger, Annamarie;
- Idoko, John;
- Longenecker, Chris;
- Mbondi, Suzanne;
- Mukaya, Japheth;
- Mutimura, Eugene;
- Ndhlovu, Chiratidzo;
- Praygod, George;
- Pefura Yone, Eric;
- Pujades-Rodriguez, Mar;
- Range, Nyagosya;
- Sani, Mahmoud;
- Schutte, Aletta;
- Sliwa, Karen;
- Vorster, Este;
- Walsh, Corinna;
- Zinyama, Rutendo;
- Mashili, Fredirick;
- Sobngwi, Eugene;
- Adebamowo, Clement;
- Kamali, Anatoli;
- Seeley, Janet;
- Young, Elizabeth;
- Smeeth, Liam;
- Motala, Ayesha;
- Kaleebu, Pontiano;
- Sandhu, Manjinder;
- Tien, Phyllis;
- Dillon, David
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 RESULTS: Data were obtained from 49 published and 3 unpublished studies which reported on 29 755 individuals.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.
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