COVID-19 severity and clinical outcomes among HIV-positive patients with diabetes and hypertension: A retrospective study at Soroti and Mbale Hospitals, Uganda

The estimated number of people living with HIV (PLHIV) in India in 2023 is 2.54 million (range 2.16-3.03 million). With the initiation of antiretroviral therapy (ART) and the "Test and Treat" policy, the life expectancy of PLHIV on ART has substantially increased, consequently leading to a higher rate of comorbidities among PLHIV. The Joint United Nations Programme on HIV/AIDS (UNAIDS) 2025 targets aim for about 90% of PLHIV to have access to integrated and comprehensive health care services, with a concerted effort to reach the End of AIDS by 2030. Hence, the National Integrated Bio-Behavioral Surveillance (IBBS) among PLHIV (IBBS-PLHIV) has been implemented for the first time in India to establish a baseline understanding of the prevalence of sexually transmitted infections (STIs), noncommunicable diseases (NCDs), and related risk behaviors among PLHIV. The primary aim of IBBS-PLHIV is to estimate the levels of HIV-related risk behaviors and the prevalence of other STIs and NCDs among PLHIV. The specific objectives are identifying the levels of HIV-related sexual and injecting risk behaviors; estimating the prevalence of STIs such as syphilis, hepatitis B virus, and hepatitis C virus; estimating the prevalence of NCDs such as diabetes and hypertension; understanding the lifestyle and behavioral risks associated with NCDs; and assessing the levels of violence, stigma, and discrimination experienced by PLHIV. IBBS-PLHIV will be a cross-sectional, biennial surveillance among PLHIV aged 15 years or older. The first round will be implemented at 120 ART centers across 28 states, accounting for approximately 95% of the total estimated PLHIV. Consenting, eligible PLHIV will be recruited through consecutive sampling. The overall sample size at each ART center is approximately 225, and the surveillance period is 3 months. Behavioral data on demographics, reproductive and sexual health, lifestyle and sexual behaviors, stigma, and discrimination will be collected. Blood samples will also be collected to test for STIs and NCDs. IBBS-PLHIV was initiated on January 1, 2024, in a phased manner. Data collection was carried out over 3 months and completed by June 2024 across all 120 sites. A total of 25,257 PLHIV were recruited for the surveillance, including 11,921 males, 11,855 females, and 1481 hijra/transgender individuals. Data entry, followed by data matching and validation of all records, was completed in December 2024. The data are currently being analyzed, and the final findings are expected to be disseminated by December 2025. Data collected through IBBS-PLHIV will help monitor the levels of HIV-related sexual and injecting risk behaviors among PLHIV. Additionally, it will provide estimates of the prevalence of NCD comorbidities and STI coinfections such as diabetes, hypertension, syphilis, and viral hepatitis. These findings will serve as a baseline and are expected to offer valuable insights for facilitating comprehensive HIV care and management through the effective integration of HIV and broader health service delivery. DERR1-10.2196/58252.

ObjectivesTo estimate the burden of non‐communicable diseases (NCDs) and mortality among PLHIV in the pre‐, early‐ and late‐HAART (highly active antiretroviral therapy) era.MethodsWe conducted a cohort study using population‐based Danish medical registries including all adult HIV‐infected residents of the Central Denmark Region during 1985–2017. For each HIV patient, we selected 10 comparisons from the background population matched by age, sex and municipality of residence. Based on hospital‐related diagnoses we estimated the prevalence and incidence of specific NCD at diagnosis and at 5 and 10 years.ResultsWe identified 1043 PLHIV and 10 430 matched comparisons. PLHIV had lower socioeconomic status and more were born outside western Europe. At HIV diagnosis, 21.9% of PHLIV vs. 18.2% of non‐HIV individuals had at least one NCD, increasing to 42.2% vs. 25.9% after 10 years. PLHIV had higher prevalence and cumulative incidence of alcohol abuse, chronic obstructive pulmonary disease (COPD), ischaemic heart disease, mental disorders, renal and liver disease, but no increased risk of diabetes mellitus. Only PLHIV in the age groups 41–50 and > 51 years had an increased incidence of osteoporosis. From the pre‐ to the late‐HAART era, 10‐year mortality among PLHIV decreased from 45.5% to 9.4% but continued at more than twice that of uninfected comparisons. However, in the late‐HAART era, the mortality of PLHIV who were alive 2 years after HIV diagnosis was approaching that of comparisons.ConclusionsEven in the late‐HAART era, PLHIV have an excess mortality, which may be attributable to several NCDs being more prevalent among PLHIV. The prevalence rates of ischaemic heart disease, diabetes, osteoporosis and renal disease tend to increase over calendar time. Therefore, improvement of survival and quality of life of PLHIV neets strategies to reduce the risk of developing NCDs, including avoiding toxic antiretroviral therapy and lifestyle changes.

BACKGROUND The escalating burden of non-communicable diseases (NCDs) in Indonesia poses a significant public health challenge. While mHealth technologies offer a promising solution, their widespread adoption and integration into primary healthcare services remain crucial for effective NCD management. The ASIK mobile application, as part of the Satu Sehat Platform, represents a valuable such mHealth tool for improving NCD screening and monitoring in Indonesia. OBJECTIVE This study aims to describe the utilization of ASIK as an integrated primary care outreach activity reporting system and its use for electronically recording of NCDs screening in Public Health Center (Puskesmas) and Community Health Post (Posbindu) in Indonesia, from January 2023 to April 2024. METHODS This study investigates the utilization of the ASIK mobile application as a non-communicable diseases (NCDs) screening reporting system. Healthcare workers and health cadres input screening data into the application, which is subsequently accessible on a monitoring dashboard. To optimize data analysis and coverage, integration with the existing SIPTM information system at the Ministry of Health (MoH) was implemented. Descriptive analysis was performed using open-source programming languages Python and R to characterize the NCDs screening results and assess the utilization coverage of ASIK. RESULTS Based on the data recorded using ASIK, it was noted that there were 116,013,364 visits with a total of 75,822,322 participants in NCDs early detection screenings from January 2023 to April 2024, recorded from 10,131 (97.1%; 10,131/10,438) Puskesmas. A total of 68,372,564 (90.17%) people had blood pressure screening, 45,108,864 (59.49%) blood sugar screening, 65,156,641 (85.93%) Body Mass Index (BMI) measurement, 3,295,802 (4.35%) cholesterol screening, 60,331,731 (79.57%) waist circumference measurement, 50,606,659 (66.74%) hearing test, 45,006,175 (59.36%) vision test, 4,706,124 (11.13%) cervical cancer screening, and 6,379,842 (15.06%) breast cancer screening. Further analysis showed that NCD conditions were more prevalent in women compared to men and had the highest prevalence in the 45-59 age group. CONCLUSIONS This study highlights the potential of mHealth technologies, exemplified by the ASIK mobile application, to effectively address and implement non-communicable diseases (NCDs) screening in Indonesia. By improving access to healthcare and enhancing patient engagement, mHealth can significantly contribute to better NCD prevention, management, and outcomes.

BACKGROUND: In rural Uganda, there exists a paucity of data on the prevalence and factors associated with non-communicable diseases (NCDs) among people living with HIV, despite heightened concerns about their increased susceptibility. Therefore, this study aims to investigate the prevalence and assess factors associated with selected NCDs, namely hypertension, type 2 diabetes, and depression, among people living with HIV (PLHIV) seeking HIV care at Kalisizo Hospital. METHODS: A cross-sectional study was conducted at Kalisizo Hospital, involving a randomly selected sample of 290 individuals living with HIV between August 8th and 24th, 2020. Data on socio-demographics, lifestyle, and clinical characteristics were collected using an adapted WHO steps questionnaire, a medical records review, and a patient Health Questionnaire-9. We further conducted anthropometric and laboratory measurements. Statistical analysis was performed using STATA Version 15.0, employing Modified Poisson regression. RESULTS: The overall prevalence of NCDs was 39.7% (95% CI=34.2%-45.4%). This prevalence was higher among participants with tertiary education (aPR=1.55, 95% CI=1.05,2.77, p=0.026), those who were obese (aPR=2.01, 95% CI=1.40,2.87, p<0.001), individuals in WHO clinical staging 3 and 4 of HIV (aPR=1.45, 95% CI=1.02,2.05, p=0.037), and those with unhealthy dietary habits (aPR=1.61, 95% CI=1.20,2.16, p=0.002). CONCLUSION: This study unveiled a significant prevalence of NCDs among PLHIV seeking HIV care at Kalisizo Hospital. This highlights the pressing necessity for swift and impactful measures to be taken by the Ugandan government, development partners, and other stakeholders. It is imperative to implement tailored interventions designed to address the high NCD prevalence observed in PLHIV who are obese, engage in unhealthy dietary habits, possess tertiary education, and fall into WHO clinical stage 3 or 4 of HIV.

Objectives Despite the advances in antiretroviral treatment (ART), persistent inflammation remained a challenge. We analyzed the inflammatory-score changes through 2-years in people living with HIV (PLWH) treated with different antiretroviral regimes. Methods This study was conducted in Hacettepe University HIV/AIDS Treatment and Research Center. PLWH diagnosed between 2014-2020 were included. Inflammatory and metabolic markers (CD4/CD8 ratio, C-reactive protein (CRP), Systemic Inflammatory Index (SII), Neutrophil-Lymphocyte Ratio (NLR), Mean Platelet Volume (MPV), Platecrite (PCT), and Low-Density Lipoprotein/High-Density Lipoprotein (LDL/HDL), Platelet-to-Lymphocyte Ratio (PLR)) and ARTs were captured from database through 2-years from the diagnosis. The 2-year change (Δ) in markers was calculated and compared by ART type (backbone and 3rd agent). Mann-Whitney-U test and T-test were used for statistical analysis. Results This study included 205 PLWH; 175 (85.4%) were male, and the mean age was 38.98 (±10.88) years. The number of PLWH with suppressed viremia (<40 HIV-RNA copies/ml) was 164 (80%) at the end of the second year. MPV increased significantly higher among PLWH receiving ABC/3TC compared to PLWH receiving TDF/FTC (p<0.05). The CD4:CD8 ratio increased, and SII, NLR, LDL/HDL ratios decreased significantly among PLWH treated with integrase strand transfer inhibitors (INSTI) compared with protease inhibitors (PI) and Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs) (p<0.05). Conclusions : Integrase inhibitor treatment is related to favorable inflammatory marker profile among PLWH in the 2-year follow-up. A favorable inflammatory profile may, in turn, contribute to the prevention of non-communicable diseases (NCD) among PLWH. This study showed that simple, easy-to-calculate markers could be implemented to define ongoing inflammation among PLWH under suppressive ART.

The remarkable progress made in confronting the global HIV epidemic offers a unique opportunity to address the increasing threat of noncommunicable diseases (NCDs). However, questions remain about how to enhance the HIV platforms to deliver integrated HIV and NCD care to people living with HIV (PLHIV) in sub-Saharan Africa (SSA). We aimed to develop a priority research agenda to advance this effort. Researchers, policymakers, and implementers from the United States and SSA conducted three scoping reviews on HIV/NCD prevention and care focused on clinical, health system, and community levels. Based on the review findings and expert inputs, we conducted iterative consensus-development activities to generate a prioritized research agenda. Population-level data on NCD prevalence among PLHIV in SSA are sparse. The review identified NCD screening and management approaches that could be integrated into HIV programs in SSA. However, few studies focused on the effectiveness, cost, and best practices for integrated chronic care platforms, making it difficult to derive policy recommendations. To address these gaps, we propose a prioritized research agenda focused on developing evidence-based service delivery models, increasing human capacity through workforce education, generating data through informatics platforms and research, managing the medication supply chain, developing new financing and sustainability models, advancing research-informed policy, and addressing other crosscutting health system issues. Based on collaborative, interdisciplinary efforts, a research agenda was developed to provide guidance that advances efforts to adapt the current health system to deliver integrated chronic care for PLHIV and the population at large.

Tuberculosis preventive therapy (TPT) reduces TB-related morbidity and mortality in people living with HIV (PLHIV). Cascade-of-care analyses help identify gaps and barriers in care and develop targeted solutions. A previous latent tuberculosis infection (LTBI) cascade-of-care analysis showed only 18% of persons in at-risk populations complete TPT, but a similar analysis for TPT among PLHIV has not been completed. We conducted a meta-analysis to provide this evidence. We first screened potential articles from a LTBI cascade-of-care systematic review published in 2016. From this study, we included cohorts that reported a minimum of 25 PLHIV. To identify new cohorts, we used a similar search strategy restricted to PLHIV. The search was conducted in Medline, Embase, Health Star, and LILACS, from January 2014 to February 2021. Two authors independently screened titles and full text and assessed risk of bias using the Newcastle-Ottawa Scale for cohorts and Cochrane Risk of Bias for cluster randomized trials. We meta-analyzed the proportion of PLHIV completing each step of the LTBI cascade-of-care and estimated the cumulative proportion retained. These results were stratified based on cascades-of-care that used or did not use LTBI testing to determine eligibility for TPT. We also performed a narrative synthesis of enablers and barriers of the cascade-of-care identified at different steps of the cascade. A total of 71 cohorts were included, and 70 were meta-analyzed, comprising 94,011 PLHIV. Among the PLHIV included, 35.3% (33,139/94,011) were from the Americas and 29.2% (27,460/94,011) from Africa. Overall, 49.9% (46,903/94,011) from low- and middle-income countries, median age was 38.0 [interquartile range (IQR) 34.0;43.6], and 65.9% (46,328/70,297) were men, 43.6% (29,629/67,947) were treated with antiretroviral therapy (ART), and the median CD4 count was 390 cell/mm3 (IQR 312;458). Among the cohorts that did not use LTBI tests, the cumulative proportion of PLHIV starting and completing TPT were 40.9% (95% CI: 39.3% to 42.7%) and 33.2% (95% CI: 31.6% to 34.9%). Among cohorts that used LTBI tests, the cumulative proportions of PLHIV starting and completing TPT were 60.4% (95% CI: 58.1% to 62.6%) and 41.9% (95% CI:39.6% to 44.2%), respectively. Completion of TPT was not significantly different in high- compared to low- and middle-income countries. Regardless of LTBI test use, substantial losses in the cascade-of-care occurred before treatment initiation. The integration of HIV and TB care was considered an enabler of the cascade-of-care in multiple cohorts. Key limitations of this systematic review are the observational nature of the included studies, potential selection bias in the population selection, only 14 cohorts reported all steps of the cascade-of-care, and barriers/facilitators were not systematically reported in all cohorts. Although substantial losses were seen in multiple stages of the cascade-of-care, the cumulative proportion of PLHIV completing TPT was higher than previously reported among other at-risk populations. The use of LTBI testing in PLHIV in low- and middle-income countries was associated with higher proportion of the cohorts initiating TPT and with similar rates of completion of TPT.

IntroductionHighly effective antiretroviral therapy has increased the life expectancy of people living with HIV (PLWH), resulting in an increase in noncommunicable diseases, including cognitive and mental health disorders. Published literature on cognitive performance in older PLWH is scarce in low- and middle-income countries, including Georgia. Our study aimed to assess mental health and cognitive performance and identify associated factors among PLWH aged ≥40 years.MethodsPrimary mental health and behavior assessments included the Drug Use Disorder Identification Test, the Alcohol Use Disorder Identification Test, the Beck Depression Inventory (BDI), and the General Anxiety Disorder 7 (GAD-7). Cognitive assessments included the Montreal Cognitive Assessment (MoCA); Trail Making Tests A and B; verbal fluency; Stroop 1, 2, and 3; and Grooved Pegboard. Univariate and multivariable regression analyses were performed to identify factors associated with cognitive performance.ResultsOur sample included 125 PLWH (78 men, 47 women). Drug use–related problems or drug dependence was observed in 36% and hazardous or harmful alcohol consumption among 23%. Mild to extreme depressive symptoms were observed among 51% and mild to severe anxiety among 47%. A MoCA score <26 was observed among 89%. Multivariable regression analyses showed higher mean scores on the Stroop Test 3 associated with higher scores on the GAD-7 (β=.40; 95% CI, 0.12-0.68) and BDI (β=.70; 95% CI, 0.17–1.2). No other associations were observed.ConclusionThis study shows high percentages of psychiatric and cognitive morbidities among older PLWH in Georgia. Longitudinal studies should be conducted to evaluate cognitive performance and associated factors among older PLWH in Georgia.

Seroprevalence, Neutralizing Antibody Titers Following Infection, and COVID-19 Disease Severity Differ Among People With and Without HIV

HIV infection, a communicable disease, and noncommunicable diseases (NCDs) are among the major health concerns worldwide. An estimated 33 million people live with HIV, two-thirds of them in sub-Saharan Africa, where three-fourths of all AIDS-related deaths occur.

Higher Risk of Inflamm-Aging in HIV-1 Infected Patients Due to Persistent Inflammation Following Long-Term Successful Antiretroviral Therapy

There is no correlation between HIV per se and other risk factors for severe COVID-19 disease. Pivotal studies have shown that vaccination is one of the effective ways to prevent severe COVID-19 illness in the general population. Studies on people living with HIV (PLWH) are scarce. The majority of these studies with mRNA (BNT126b2 and mRNA-1273) and adenovirus vector (Ad26.COV2.2 and ChAdOx1) vaccines with a low number of patients included shows that PLWH on antiretroviral treatment and with CD4 count > 200/mm³ has a robust immune response. These vaccines are thus effective in preventing severe infection caused by severe acute respiratory syndrome coronavirus 2 in PLWH. However, PLWH with a CD4 count of < 200/mm³ and uncontrolled viral load (VL) seems to have a lower immune response. COVID-19 vaccines are safe in PLWH; adverse effects are mild or moderate, and their incidence is similar to non-HIV people (NHP). The CD4 count decreased significantly and transiently, and the VL rebounded insignificantly in a few patients. A complete vaccination including a third dose is, therefore, recommended. A booster dose with an mRNA vaccine is recommended in PLWH with an advanced stage of their disease.

BackgroundThe prevalence of non-communicable diseases (NCDs) is rising in low and middle-income countries (LMIC). We aimed to report on the prevalence of NCDs in pregnancy and their associated perinatal outcomes in a regional hospital in Haiti.MethodsWe conducted the “Diabète et hYpertension Artéerielle et leurs issues MAternelles et Néonatales” (DYAMAN) prospective cohort study in a regional hospital in Haiti. Pregnant women presenting to care at 24-28 weeks were screened and treated for diabetes (DM) and hypertensive disorders of pregnancy (HDP) using setting-adapted protocols. Prevalence of NCDs and associated maternal-neonatal outcomes were described.Results715 women were included, of which 51 (7.1%) had DM, 90 (12.6%) had HDP, and 30 (4.2%) had both DM and HDP (DM/HDP). Of 422 (59%) women delivered in hospital, 58 (13.7%) had preeclampsia, including 5 (8.6%) with eclampsia. Preterm birth <32 weeks was more common in the HDP than the control, DM, and DM/HDP groups. More low birth weight babies (n = 20, 25.6%) were born to the HDP group than to the control (n = 20, 7.1%), DM (n = 1, 2.7%), and DM/HDP (n = 3, 12%) groups (P < 0.001). Macrosomia and hypoglycemia affected 5 (8%) neonates of women with DM. Perinatal mortality, affecting 36/1000 births, was mainly driven by maternal NCDs.ConclusionsNCDs in pregnancy led to adverse maternal and perinatal outcomes. This study will help to prepare future refinements aimed at optimizing the management of NCDs in pregnancy in LMIC. Research is required to understand barriers to patient attendance at antenatal follow-up, treatment escalation for hyperglycemia, and in-hospital delivery.

The prevalence of obesity has increased dramatically in recent decades worldwide. An increase in the prevalence of obesity has also been observed among people living with HIV (PLHIV) in high and low incomes countries. Antiretroviral therapy (ART), by controlling the viral load (VL) and restoring cellular immunity, has improved the health status and life expectancy in PLHIV. However, the risk of developing non-AIDS events (NAEs) remains higher than the general population. Therefore, specific attention is given to managing risk factors associated with NAEs during the follow-up of PLHIV, including obesity. Factors related to weight gain in PLHIV include demographic factors, HIV disease-related factors, and ART-associated factors. In naive PLHIV, weight gain after the initiation of ART is expected. The weight gains observed are generally not severe even if there appear to be risk factors such as the advanced stage of disease (low CD4 cells count and high VL), female sex, black race, and taking integrase strand transfer inhibitors (INSTI) associated or not with tenofovir alafenamide fumarate (TAF). The role of each antiretroviral drug per-se remains to clarify. As INSTI ± TAF has been associated with significant weight gain, further research is needed to identify the individual-level factors predictive of weight gain, the mechanisms of ART-associated weight gain and the clinical relevance of this weight gain. As PLHIV survive longer on effective ART, the prevention and management of NAEs will remain a challenge for healthcare providers.

Rallying United Nations organizations in the fight against noncommunicable diseases