Noncommunicable diseases among HIV-infected persons in low-income and middle-income countries: a systematic review and meta-analysis

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Abstract

<div class="section"> <a class="named-anchor" id="S1">  </a> <h5 class="section-title" id="d3541535e216">Objective:</h5> <p id="P2">To appropriately identify and treat noncommunicable diseases (NCDs) among persons living with HIV (PLHIV) in low-and-middle-income countries (LMICs), it is imperative to understand the burden of NCDs among PLHIV in LMICs and the current management of the diseases. </p> </div><div class="section"> <a class="named-anchor" id="S2">  </a> <h5 class="section-title" id="d3541535e221">Design:</h5> <p id="P3">Systematic review and meta-analysis.</p> </div><div class="section"> <a class="named-anchor" id="S3">  </a> <h5 class="section-title" id="d3541535e226">Methods:</h5> <p id="P4">We examined peer-reviewed literature published between 1 January 2010 and 31 December 2016 to assess currently available evidence regarding HIV and four selected NCDs (cardiovascular disease, cervical cancer, depression, and diabetes) in LMICs with a focus on sub-Saharan Africa. The databases, PubMed/MEDLINE, Cochrane Review, and Scopus, were searched to identify relevant literature. For conditions with adequate data available, pooled estimates for prevalence were generated using random fixed effects models. </p> </div><div class="section"> <a class="named-anchor" id="S4">  </a> <h5 class="section-title" id="d3541535e231">Results:</h5> <p id="P5">Six thousand one hundred and forty-three abstracts were reviewed, 377 had potentially relevant prevalence data and 141 were included in the summary; 57 were selected for quantitative analysis. Pooled estimates for NCD prevalence were hyper-tension 21.2% (95% CI 16.3–27.1), hypercholesterolemia 22.2% (95% CI 14.7–32.1), elevated low-density lipoprotein 23.2% (95% CI 15.2–33.6), hypertriglyceridemia 27.2% (95% CI 20.7–34.8), low high-density lipoprotein 52.3% (95% CI 35.6–62.8), obesity 7.8% (95% CI 4.3–13.9), and depression 24.4% (95% CI 12.5–42.1). Invasive cervical cancer and diabetes prevalence were 1.3–1.7 and 1.3–18%, respectively. Few NCD-HIV integrated programs with screening and management approaches that are contextually appropriate for resource-limited settings exist. </p> </div><div class="section"> <a class="named-anchor" id="S5">  </a> <h5 class="section-title" id="d3541535e236">Conclusion:</h5> <p id="P6">Improved data collection and surveillance of NCDs among PLHIV in LMICs are necessary to inform integrated HIV/NCD care models. Although efforts to integrate care exist, further research is needed to optimize the efficacy of these programs. </p> </div>

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Meta-analysis of the relationship between HIV infection and risk for depressive disorders.

J A Ciesla, J Roberts (2001)

Each of 10 published studies investigating the relationship between HIV infection and risk for depressive disorders concluded that HIV-positive individuals are at no greater risk for depression than comparable HIV-negative individuals. This study used meta-analytic techniques to further examine the relationship between depressive disorders and HIV infection. Meta-analytic techniques were used to aggregate and reanalyze the data from 10 studies that compared HIV-positive and HIV-negative individuals for rates of major depressive disorder (N=2,596) or dysthymic disorder (N=1,822). The frequency of major depressive disorder was nearly two times higher in HIV-positive subjects than in HIV-negative comparison subjects. On the other hand, findings were inconclusive with regard to dysthymic disorder. Rates of depression do not appear to be related to the sexual orientation or disease stage of infected individuals. Although the majority of HIV-positive individuals appear to be psychologically resilient, this meta-analysis provides strong evidence that HIV infection is associated with a greater risk for major depressive disorder. Future research should focus on identifying pathways of risk and resilience for depression within this population.

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Cardiovascular risk and body-fat abnormalities in HIV-infected adults.

Steven Grinspoon, Andrew W. Carr (2005)

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Group interpersonal psychotherapy for depression in rural Uganda: a randomized controlled trial.

Paul Bolton, Judith D. Bass, Richard Neugebauer … (2003)

Despite the importance of mental illness in Africa, few controlled intervention trials related to this problem have been published. To test the efficacy of group interpersonal psychotherapy in alleviating depression and dysfunction and to evaluate the feasibility of conducting controlled trials in Africa. For this cluster randomized, controlled clinical trial (February-June 2002), 30 villages in the Masaka and Rakai districts of rural Uganda were selected using a random procedure; 15 were then randomly assigned for studying men and 15 for women. In each village, adult men or women believed by themselves and other villagers to have depressionlike illness were interviewed using a locally adapted Hopkins Symptom Checklist and an instrument assessing function. Based on these interviews, lists were created for each village totaling 341 men and women who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for major depression or subsyndromal depression. Interviewers revisited them in order of decreasing symptom severity until they had 8 to 12 persons per village, totaling 284. Of these, 248 agreed to be in the trial and 9 refused; the remainder died or relocated. A total of 108 men and 116 women completed the study and were reinterviewed. Eight of the 15 male villages and 7 of the 15 female villages were randomly assigned to the intervention arm and the remainder to the control arm. The intervention villages received group interpersonal psychotherapy for depression as weekly 90-minute sessions for 16 weeks. Depression and dysfunction severity scores on scales adapted and validated for local use; proportion of persons meeting DSM-IV major depression diagnostic criteria. Mean reduction in depression severity was 17.47 points for intervention groups and 3.55 points for controls (P<.001). Mean reduction in dysfunction was 8.08 and 3.76 points, respectively (P<.001). After intervention, 6.5% and 54.7% of the intervention and control groups, respectively, met the criteria for major depression (P<.001) compared with 86% and 94%, respectively, prior to intervention (P =.04). The odds of postintervention depression among controls was 17.31 (95% confidence interval, 7.63-39.27) compared with the odds among intervention groups. Results from intention-to-treat analyses remained statistically significant. Group interpersonal psychotherapy was highly efficacious in reducing depression and dysfunction. A clinical trial proved feasible in the local setting. Both findings should encourage similar trials in similar settings in Africa and beyond.