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

2. 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 :45-16:15 B5 Non-Communicable Diseases and HIV Infection
Bernard Cerutti, Alain Amstutz, Isaac Ringera, Kyaw Thin, Tracy Glass, Niklaus D. Labhardt

3. Background
Non-communicable diseases and their risk-factors have been increasing in sub-Saharan Africa
A 109% increase in diabetes mellitus is expected from 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

4. 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

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

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

7. 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 + -

8. 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) - +

9. 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) - +

10. 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 33
.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 - +

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

12. 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
.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 - +

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

14. HbA1c %
BMI
Age

15. 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
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% - +

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

17. 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 - +

18. 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

19. 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 - +