Sascha Albrecht1,2,3, Fabian C Franzeck4, Herry Mapesi1,2,3,5, Christoph Hatz1,2, Aneth Vedastus Kalinjuma3, Tracy R Glass1,2, Dorcas Mnzava3, Emili Letang1,2,3,6, Daniel H Paris1,2, Manuel Battegay4, Maja Weisser1,2,3,4. 1. Swiss Tropical and Public Health Institute, Basel. 2. University of Basel, Basel, Switzerland. 3. Ifakara Health Institute, Ifakara, United Republic of Tanzania. 4. Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland. 5. Saint Francis Referral Hospital, Ifakara, United Republic of Tanzania. 6. ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.
Abstract
OBJECTIVE: Causes of morbidity and mortality of people living with HIV are changing with access to antiretroviral therapy and increased life expectancy. Age-related data on comorbidities and their impact on mortality in sub-Saharan Africa are scarce. DESIGN: This prospective analysis evaluated comorbidities, assessed by means of International Classification of Diseases and Related Health problems 10th revision codes and clinical variables, derived from data collected from the Kilombero & Ulanga antiretroviral cohort of people living with HIV in rural Tanzania. METHODS: We calculated prevalences and incidences of comorbidities in patients enrolled from 2013 to 2017 and evaluated their association with a combined endpoint of death and loss to follow-up (LTFU) in various age groups (15-29, 30-49 and ≥50 years) using Cox regression analysis. RESULTS: Of 1622 patients [65% females, median age 38 years (interquartile range 31-46)], 11% were at least 50 years. During a median follow-up of 22.1 months (interquartile range 10.6-37.3), 48 (2.9%) patients died and 306 (18.9%) were LTFU. Anaemia was the most prevalent comorbidity (66.3%) irrespective of age and was associated with increased mortality/LTFU [hazard ratios 2.02 (95% confidence interval (CI) 1.57-2.60); P < 0.001]. In patients aged at least 50 years, arterial hypertension was highly prevalent (43.8%), but not associated with mortality/LTFU [hazard ratios 1.04 (95% CI 0.56-1.93), P = 0.9]. Undernutrition ranged from 25.5% in the youngest to 29.1% in the oldest age group and contributed to mortality/LTFU [hazard ratios 2.24 (95% CI 1.65-3.04); P < 0.001]. Prevalence of tuberculosis was 21.4% with hazard ratios of 2.54 (95% CI 1.72-3.75, P < 0.001) for mortality/LTFU. CONCLUSION: We show that anaemia, arterial hypertension and undernutrition are the most relevant comorbidities with different age-associated frequencies and impact on death/LTFU in this population.
OBJECTIVE: Causes of morbidity and mortality of people living with HIV are changing with access to antiretroviral therapy and increased life expectancy. Age-related data on comorbidities and their impact on mortality in sub-Saharan Africa are scarce. DESIGN: This prospective analysis evaluated comorbidities, assessed by means of International Classification of Diseases and Related Health problems 10th revision codes and clinical variables, derived from data collected from the Kilombero & Ulanga antiretroviral cohort of people living with HIV in rural Tanzania. METHODS: We calculated prevalences and incidences of comorbidities in patients enrolled from 2013 to 2017 and evaluated their association with a combined endpoint of death and loss to follow-up (LTFU) in various age groups (15-29, 30-49 and ≥50 years) using Cox regression analysis. RESULTS: Of 1622 patients [65% females, median age 38 years (interquartile range 31-46)], 11% were at least 50 years. During a median follow-up of 22.1 months (interquartile range 10.6-37.3), 48 (2.9%) patientsdied and 306 (18.9%) were LTFU. Anaemia was the most prevalent comorbidity (66.3%) irrespective of age and was associated with increased mortality/LTFU [hazard ratios 2.02 (95% confidence interval (CI) 1.57-2.60); P < 0.001]. In patients aged at least 50 years, arterial hypertension was highly prevalent (43.8%), but not associated with mortality/LTFU [hazard ratios 1.04 (95% CI 0.56-1.93), P = 0.9]. Undernutrition ranged from 25.5% in the youngest to 29.1% in the oldest age group and contributed to mortality/LTFU [hazard ratios 2.24 (95% CI 1.65-3.04); P < 0.001]. Prevalence of tuberculosis was 21.4% with hazard ratios of 2.54 (95% CI 1.72-3.75, P < 0.001) for mortality/LTFU. CONCLUSION: We show that anaemia, arterial hypertension and undernutrition are the most relevant comorbidities with different age-associated frequencies and impact on death/LTFU in this population.
Authors: Guiying Cao; Hai Long; Yuedong Liang; Jue Liu; Xiaoxin Xie; Yanhua Fu; Juan He; Su Song; Siqi Liu; Manna Zhang; Yu Wu; Yaping Wang; Min Du; Wenzhan Jing; Jie Yuan; Min Liu Journal: BMJ Open Date: 2022-07-18 Impact factor: 3.006
Authors: Laura-Marie Stieglitz; Till Bärnighausen; Germana H Leyna; Patrick Kazonda; Japhet Killewo; Julia K Rohr; Stefan Kohler Journal: J Multimorb Comorb Date: 2022-02-22
Authors: Armon Arpagaus; Fabian Christoph Franzeck; George Sikalengo; Robert Ndege; Dorcas Mnzava; Martin Rohacek; Jerry Hella; Klaus Reither; Manuel Battegay; Tracy Renee Glass; Daniel Henry Paris; Farida Bani; Omary Ngome Rajab; Maja Weisser Journal: PLoS One Date: 2020-03-04 Impact factor: 3.240