HIV This Week

Janssens B, Van Damme W, Raleigh B, Gupta J, Khem S, Soy Ty K, Vun M, Ford N, Zachariah R. Offering integrated care for HIV/AIDS, diabetes and hypertension within chronic disease clinics in Cambodia. Bull World Health Organ. 2007; 85(11):880-5.

In Cambodia, care for people living with HIV (prevalence 1.9%) is expanding, but care for people with type II diabetes (prevalence 5-10%), arterial hypertension, and other treatable chronic diseases remains very limited. Janssens and colleagues describe the experience and outcomes of offering integrated care for HIV, diabetes, and hypertension within the setting of chronic disease clinics. Chronic disease clinics were set up in the provincial referral hospitals of Siem Reap and Takeo, 2 provincial capitals in Cambodia. At 24 months of care, 87.7% of all HIV patients were alive and in active follow-up. For diabetes patients, this proportion was 71%. Of the HIV patients, 9.3% had died and 3% were lost to follow-up, while for diabetes this included 3 (0.1%) deaths and 28.9% lost to follow-up. Of all diabetes patients who stayed more than 3 months in the cohort, 90% were still in follow-up at 24 months. Over the first three years, the chronic disease clinics have demonstrated the feasibility of integrating care for HIV with non-communicable chronic diseases in Cambodia. Adherence support strategies proved to be complementary, resulting in good outcomes. Services were well accepted by patients, and this has had a positive effect on HIV -related stigma. This experience shows how care for HIV patients can act as an impetus to tackle other common chronic diseases.

Editors’ note: With antiretroviral therapy becoming more accessible in resource-constrained settings, HIV care is increasingly becoming chronic disease management. Integrating care for HIV, diabetes, and hypertension can have efficiency gains, improved patient outcomes, and reduction in HIV-related stigma. In many settings, HIV care has introduced adherence support functions into the health care system. These can be applied to other chronic diseases, often neglected despite their disease burden, that also require sustained adherence to medication and lifestyle changes.

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Bärnighausen T, Welz T, Hosegood V, Bätzing-Feigenbaum J, Tanser F, Herbst K, Hill C, Newell ML. Hiding in the shadows of the HIV epidemic: obesity and hypertension in a rural population with very high HIV prevalence in South Africa. J Hum Hypertens. 2008; 22(3):236-9..

Bärnighausen and colleagues conducted a large population-based survey of body mass and blood pressure nested within an HIV survey in rural KwaZulu-Natal, South Africa, to measure the prevalence of obesity and hypertension in a community with very high HIV prevalence and to investigate the effect of HIV on body mass and blood pressure in a general population in rural Africa before antiretroviral treatment was widely available. Crude prevalence of overweight, obesity, stage-I and stage-II hypertension was 58% (95% confidence interval (CI) 56–60%), 32% (95% CI 30–33%), 24% (95% CI 22–26%) and 9% (95% CI 8–10%), respectively. Controlling for age, sex, education, household wealth, marital status and rural vs urban residence in multiple regression (after multiple imputation of missing values), HIV infection reduced body mass index by 1.9 units (Po0.001) and––when additionally controlling for body mass––systolic blood pressure by 3.0mmHg (P¼0.005).

Editors’ note: Despite an HIV prevalence of 35% in this 2003-2004 population-based survey, more than half of people were overweight, a third were obese and a third had high blood pressure. HIV had an effect on body mass index equivalent to a 5 kg. weight reduction and was a significant predictor of lower systolic blood pressure – findings that will likely be reversed as antiretroviral treatment is scaled up. This highlights the relevance of integrated chronic disease management to increase antihypertensive treatment coverage and promote lifestyle modification for HIV patients starting on antiretroviral treatment, as well as for the general population.