Comparison of lipid profile and glycosylated hemoglobin levels among HIV-infected and non-HIV-infected individuals in Lesotho: a community-based cross-sectional study

Comparison of lipid profile and glycosylated hemoglobin levels among HIV-infected and non-HIV-infected individuals in Lesotho: a community-based cross-sectional study Track B: Clinical Science, Treatment and Care 06.12.2017 14:45-16:15 B5 Non-Communicable Diseases and HIV Infection Bernard Cerutti, Alain Amstutz, Isaac Ringera, Kyaw Thin, Tracy Glass, Niklaus D. Labhardt

Background Non-communicable diseases and their risk-factors have been increasing in sub-Saharan Africa A 109% increase in diabetes mellitus is expected from 2013 to 2055 Few data are available regarding Lesotho Number of data sources available for BMI and diabetes, All sources. From: NCD Risk Factor Collaboration (NCD-RisC) – Africa Working Group: Trends in obesity and diabetes across Africa from 1980 to 2014: an analysis of pooled population-based studies. Int J Epidemiol 2017

Background Prevalence of diabetes: 6.0% (♂ 4.5%; ♀ 7.5%) 6.0% (♂ 4.5%; ♀ 7.5%) % total deaths: 3% Prevalence of obesity: 11.9.% (♂ 3.3%; ♀ 20.4%) Overweight: 31.0%(♂ 16.3%; ♀ 45.3%) World Health Organization – Diabetes country profiles, 2016 Number of data sources available for BMI and diabetes, All sources. From: NCD Risk Factor Collaboration (NCD-RisC) – Africa Working Group: Trends in obesity and diabetes across Africa from 1980 to 2014: an analysis of pooled population-based studies. Int J Epidemiol 2017

Objective Report BMI HbA1c levels Lipid profiles among HIV-negative and HIV-positive individuals from a household survey in rural Lesotho

Methods Study nested within CASCADE- trial (NCT02692027): effectiveness of same-day start of antiretroviral therapy in individuals tested HIV- positive during home-based HIV testing. District of Butha-Buthe, Northern Lesotho

Methods Inclusion criteria: ≥18 years never been on ART informed written consent Exclusion criteria: WHO Stage 4 pregnancy or breastfeeding active tuberculosis treatment for known chronic disease positive cryptococcal antigen test Matching: gender and age preferably within the same household + -

Methods - + Inclusion criteria: ≥18 years never been on ART informed written consent Exclusion criteria: WHO Stage 4 pregnancy or breastfeeding active tuberculosis treatment for known chronic disease positive cryptococcal antigen test Matching: gender and age preferably within the same household No imputation for missing values (1.4% for HbA1c, 8.8% for LDL) - +

Measures Glycated hemoglobin HbA1c: Triglycerides Total cholesterol Impaired fasting glucose if ≥ 5.6% Diabetes if ≥ 6.5% Triglycerides Total cholesterol LDL cholesterol HDL cholesterol Ratio Total cholesterol / HDL cholesterol Elevated if > 5.0 (men) Elevated if > 4.5 (women) - +

Results (median and inter-quartile range) Women HIV- 93 Women HIV+ 184 Men HIV- 39 Men HIV+ 94 ALL HIV- 132 All HIV+ 278 p-value HIV+ vs HIV - Age 41 30 - 63 29 - 53 33 28 - 53 33 - 53 29 - 58 .478 Education none 35.5% 39.1% 50.0% 66.0% 39.7% 48.2% .171 primary 54.8% 52.7% 31.6% 26.6% 48.1% 43.9% secondary or higher 9.7% 8.2% 18.4% 7.4% 12.2% 7.9% Regular income 11.1% 16.3% 19.4% 36.2% 13.5% 23.0% .027 Body Mass Index (kg/m2) 27.6 24.4 – 33.7 25.0 21.3 – 29.3 22.5 20.8 – 26.0 21.7 19.7 – 23.7 26.2 23.1 – 32.4 23.1 20.6 – 27.3 <.001 - +

Body mass index kg/m2 Women HIV- Women HIV+ Men HIV- Men HIV+ ALL HIV-

Results HbA1c % (median and inter-quartile range) Women HIV- 93 Women HIV+ 184 Men HIV- 39 Men HIV+ 94 ALL HIV- 132 All HIV+ 278 p-value HIV+ vs HIV - HBA1c % 5.50 5.17 – 5.70 5.40 5.20 – 5.60 5.20 - 5.70 .036 ≥ 5.6% and < 6.5% 41.3% 22.7% 28.2% 28.9% 37.4% 24.8% .009 ≥ 6.5% 4.3% 2.8% 2.6% 1.1% 3.8% 2.3% .373 - +

HbA1c % Women HIV- Women HIV+ Men HIV- Men HIV+ ALL HIV- All HIV+

HbA1c % BMI Age

Results LDL and HDL mmol/L (median and inter-quartile range) Women HIV- 93 Women HIV+ 184 Men HIV- 39 Men HIV+ 94 ALL HIV- 132 All HIV+ 278 p-value HIV+ vs HIV - LDL 2.40 1.80 – 2.90 2.05 1.70 – 2.50 2.20 1.70 – 2.75 1.70 1.40 – 2.23 2.35 1.70 – 2.87 2.00 1.60 – 2.40 <.001 <3.5 86.2% 97.6% 97.4% 98.8% 89.7% 98.0% ≥3.5 and <4.1 8.0% 1.8% - 1.2% 5.6% 1.6% ≥4.1 5.7% 0.6% 2.6% 4.8% 0.4% HDL 1.20 1.00 -1.40 1.00 0.80 – 1.20 1.10 0.90 – 1.40 080 – 1.20 1.00 – 1.40 Low HDL Women ≤ 1.3 Men ≤ 1.0 72.5% 86.5% 41.0% 64.8% 63.1% 79.2% - +

HDL mmol/L Women HIV- Women HIV+ Men HIV- Men HIV+ ALL HIV- All HIV+

Results Total Cholesterol and ratios (median and inter-quartile range) Women HIV- 93 Women HIV+ 184 Men HIV- 39 Men HIV+ 94 ALL HIV- 132 All HIV+ 278 p-value HIV+ vs HIV - Total cholesterol 4.25 3.50 – 5.03 3.60 3.10 – 4.20 3.90 3.30 – 4.65 3.40 2.80 – 3.93 4.20 3.40 – 4.85 3.50 3.00 – 4.20 <.001 Elevated Total / HDL Women > 4.5 Men > 5.0 26.4% 22.8% 10.3% 11.4% 21.5% 18.9% .541 Elevated LDL / HDL Women > 3.0 Men > 3.5 16.1% 12.8% 5.1% 3.6% 12.7% 9.7% .372 - +

Limitations Strength Less observations in the HIV- group No full cardio-vascular risk profile - Strength + HbA1c measure was used: it is a more reliable indicator of glucose metabolism over the last three months

Conclusion Overall prevalence of obesity, diabetes and dyslipidaemia is low in this rural population Elevated LDL was higher among HIV- individuals No evidence of a difference regarding the LDL/HDL ratio - +