Table 1.
Characteristics of included studies grouped by noncommunicable disease (NCD) and odds of NCD diagnosis comparing HIV-positive ART exposed to HIV-positive ART unexposed in each study
| Study No. | Study, Year published | Country | Dates of observation (MM/YY) | Total N (% ART+) | Total female, n (%) | Mean age (years) | Screened ART+, n (%) | Screened ART-, n (%) | Diagnostic criteria | Diagnosed ART+, n (%) | Diagnosed ART-, n (%) | Initiated treatment ART+, n (%) | Initiated treatment ART-, n (%) | Control among treated ART+, n (%) | Control among treated ART-, n (%) | Odds ratio of NCD diagnosisa (95% CI) |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Outcome = Diabetes | ||||||||||||||||
| 1 | Dave et al. [29] | South Africa | 849 (52) | 653 (77) | Fasting glucose ≥ 7 mmol/l or OGTT ≥ 11.1 mmol/l | 10 (2.2) | 14 (3.4) | 0.65 (0.28, 1.47) | ||||||||
| 2 | Sani et al. [30] | Nigeria | 05/09–08/09 | 200 (50) | 106 (53) | 32.5 | Fasting glucose ≥ 7 mmol/l or Random glucose ≥ 11.1 mmol/l | 3 (3) | 3 (3) | 1.00 (0.20, 5.08) | ||||||
| 3 | Peck et al. [31] | Tanzania | 10/12–04/13 | 301 (50) | 204 (68) | 38.5d | Self-reported via WHO STEPS questionnaire | 1 (0.7) | 1 (0.7) | 1.01 (0.06, 16.25) | ||||||
| 4 | Shey Nsagha et al. [32] | Cameroon | 03/14–08/14 | 215 (74) | 161 (75) | 43.2 | Fasting glucose ≥ 7 mmol/l | 3 (1.9) | 2 (3.6) | 0.51 (0.08, 3.11) | ||||||
| 5 | Osegbe et al. [33] | Nigeria | 200 (50) | 36.6 | Fasting glucose ≥ 7 mmol/l | 9 (9) | 2 (2) | 4.85 (1.02, 23.03) | ||||||||
| 6 | Divala et al. [34] | Malawi | 7/14–10/14 | 952 (96) | 683 (72) | 43.0 | Elevated glucose defined as fasting glucose ≥ 7 mmol/l or random glucose ≥ 11.1 mmol/l on two occasions or reported use of antidiabetic drugs | 38 (4.2) | 1 (2.6) | 0.61 (0.08, 4.53)2 | ||||||
| 7 | Kingery et al. [35] | Tanzania | 10/12–4/13 | 301 (50) | 204 (68) | 40.5 | Fasting glucose ≥ 7 mmol/l or Random glucose ≥ 11.1 mmol/l | 27 (18) | 1 (0.7) | 32.93 (4.41, 245.78) | ||||||
| 8 | Manne-Goehler et al. [21] | South Africa | 11/14–11/15 | 1035 (64) | 560 (54) | 55.4 | 324 (49) | 157 (42) | Self-reported diabetes diagnosis or glucose ≥ 7 mmol/l) in fasting group (defined as > 8 h), glucose ≥ 11.1 mmol/l in nonfasting (“random or casual”) samples. Individuals with missing fasting information were considered to be not fasting. | 52 (7.8) | 23 (6.3) | 363 (55) | 162 (44) | 1.30 (0.78, 2.16) | ||
| 9 | Osoti et al. [36] | Western Kenya | 07/14–09/14 | 300 (55) | 192 (64) | 40.7 | Fasting blood glucose ≥ 7 mmol/l | 2 (1.5) | 5 (3.1) | 0.32 (0.06, 1.69) | ||||||
| 10 | Achwoka et al. [37] | Kenya | 10/15–09/16 | 3170 (68) | 2115 (67) | Diabetes mellitus documented in medical records | 7 (0.3) | 2 (0.2) | 1.61 (0.33, 7.79) | |||||||
| 11 | Manne-Goehler et al. [38] | South Africa | 11/14–11/15 | 1035 (71) | 560 (54) | 55.4 | Fasting glucose ≥ 7 mmol/l or Random glucose ≥ 11.1 mmol/l or self-reported diagnosis of diabetes that had been made by a doctor, nurse, or healthcare worker, or self-reported use of medication for diabetes prescribed by a doctor, nurse, or healthcare worker | 59 (8.0) | 21 (7.1) | 1.17 (0.69, 1.95) | ||||||
| 12 | Sarfo et al. [39] | Ghana | 451 (55) | 367 (81) | 44.5 | History of known diabetes, use of diabetes medication, or HbA1c > 6.5% | 21 (8.4) | 19 (9.5) | 0.88 (0.46, 1.68) | |||||||
| 13 | Jeremiah et al. [40] | Tanzania | 10/16–11/17 | 1292 (26) | 786 (61) | 39.9 | HbA1c ≥ 6.5% | 26 (7.8) | 169 (17.7) | 0.39 (0.25, 0.60) | ||||||
| OGTT ≥ 11.1 mmol/l | 11 (3.3) | 87 (9.1) | 0.34 (0.18, 0.64) | |||||||||||||
| Both HbA1c ≥ 6.5% and OGTT ≥ 11.1 mmol/l | 3 (0.9) | 33 (3.5) | 0.25 (0.08, 0.83) | |||||||||||||
| 14 | Sarfo et al. [41] | Ghana | 502 (51) | 377 (75) | History of diabetes, use of medications for diabetes, or HbA1c ≥ 6.5% | 19 (7.4) | 16 (6.6) | 1.14 (0.57, 2.27) | ||||||||
| Two fasting glucose readings ≥ 7 mmol/l | 30 (11.6) | 38 (15.6) | 1.14 (0.57, 2.27) | |||||||||||||
| 15 | Roozen et al. [42] | South Africa | 07/16–11/17 | 394 (73) | 264 (67) | 39.8 | Random glucose > 11 mmol/L or use of blood glucose lowering medication | 6 (2.1) | 1 (0.9) | 2.23 (0.27, 18.78) | ||||||
| 16 | Msoka et al. [43] | Tanzania | 104 (62) | 74 (71) | 54.6 | Fasting glucose ≥ 7 mmol/l | 6 (9.4) | 2 (5.0) | 1.97 (0.38, 10.25) | |||||||
| Outcome = Hypertension | ||||||||||||||||
| 17 | Ekali et al. [44] | Cameroon | 143 (80) | 103 (72) | 39.5 | Blood pressure equal to or greater than 140/90 mmHg | 18 (15.7) | 3 (10.7) | 1.55 (0.42, 5.67) | |||||||
| 2 | Sani et al. [30] | Nigeria | 05/09–08/09 | 200 (50) | 106 (53) | 32.5 | Blood pressure equal to or greater than 140/90 mmHg | 17 (17) | 2 (2) | 10.04 (2.25, 44. 71) | ||||||
| 18 | Botha et al. [45] | South Africa | 2010 | 137 (48) | 96 (70) | 47.7 | Self-report of previous diagnosis | 20 (31.8) | 29 (40.9) | 9 (14.0) | 11 (16.0) | 0.63 (0.31, 1.28) | ||||
| 3 | Peck et al. [31] | Tanzania | 10/12–04/13 | 301 (50) | 204 (68) | 38.5d | Blood pressure equal to or greater than 140/90 mmHg | 43 (28.7) | 8 (5.3) | 7.18 (3.24, 15.91) | ||||||
| 19 | Ogunmola et al. [46] | Nigeria | 250 (52) | 156 (62) | 38.1 | Blood pressure equal to or greater than 140/90 mmHg | 16 (12.3) | 19 (15.8) | 1.47 (0.37, 5.84) | |||||||
| 4 | Shey Nsagha et al. [32] | Cameroon | 03/14–08/14 | 215 (74) | 161 (75) | 43.2 | Blood pressure equal to or greater than 140/90 mmHg | 47 (29.4) | 8 (14.5) | 2.4 (1.07, 4.52) | ||||||
| 20 | Ogunmola et al. [47] | Nigeria | 121 (63) | 86 (71) | 38.1 | Blood pressure equal to or greater than 140/90 mmHg | 9 (11.8) | 4 (8.9) | 1.38 (0.40, 4.76) | |||||||
| 5 | Osegbe et al. [33] | Nigeria | 200 (50) | 36.6 | SBP equal to or greater than 140 mmHg | 43 (43) | 23 (23) | 2.19 (1.02, 4.69) | ||||||||
| DBP equal to or greater than 90 mmHg | 20 (20) | 11 (11) | 2.02 (0.91, 4.48) | |||||||||||||
| 21 | Dimala et al. [48] | Cameroon | 04/13–06/13 | 200 (50) | 140 (70) | 39.1 | Blood pressure equal to or greater than 140/90 mmHg | 38 (38) | 19 (19) | 2.2 (1.07, 4.52)3 | ||||||
| 6 | Divala et al. [34] | Malawi | 7/14–10/14 | 952 (96) | 683 (72) | 43.0 | Blood pressure equal to or greater than 140/90 mmHg or taking anti-hypertensive medication | 216 (23.7) | 10 (25.6) | 1.11 (0.53, 2.32) | ||||||
| 7 | Kingery et al. [35] | Tanzania | 10/12–4/13 | 301 (50) | 204 (68) | 40.5 | Blood pressure equal to or greater than 140/90 mmHg | 43 (28.7) | 8 (5.3) | 10 (6.7) | 1 (0.7) | 7.18 (3.24, 15.91) | ||||
| 22 | Nduka et al. [49] | Nigeria | 08/14–11/14 | 406 (75) | 278 (69) | 37.8 | Blood pressure equal to or greater than 140/90 mmHg or current use of antihypertensive medication | 50 (16.3) | 9 (9.0) | 24 (7.8) | 4 (4.0) | 1.97 (0.93, 4.18) | ||||
| 8 | Manne-Goehler et al. [21] | South Africa | 11/14–11/15 | 1035 (64) | 560 (54) | 55.4 | 473 (71.5) | 258 (69.2) | Self-report of previous diagnosis, or systolic blood pressure ≥ 140 mmHg or diastolic ≥ 90 mmHg, or self-reported use of anti-hypertensive medication at time of interview | 256 (38.7) | 162 (43.5) | 383 (57.8) | 183 (49.1) | 0.82 (0.63, 1.06) | ||
| 10 | Achwoka et al. [37] | Kenya | 10/15–09/16 | 3170 (68) | 2115 (67) | Two or more measures taken within 12 months of systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg | 319/2170 (14.7) | 24/1000 (2.4) | 7.01 (4.60, 10.69) | |||||||
| 11 | Manne-Goehler et al. [38] | South Africa | 11/14–11/15 | 1035 (71) | 560 (54) | 55.4 | Self-report of ever diagnosed, or SBP ≥ 140 mmHg or DBP ≥ 90 mmHg, or self-reported use of anti-hypertensive medication at time of interview | 339 (46.2) | 143 (47.7) | 0.95 (0.72, 1.24) | ||||||
| 12 | Sarfo et al. [39] | Ghana | 451 (55) | 367 (81) | 44.5 | Blood pressure greater than or equal to 140/90 mmHg or history of hypertension or use of antihypertensive drugs | 92 (36.9) | 47 (23.4) | 37 (40.2) | 21 (44.7) | 11 (29.7) | 9 (42.9) | 1.91 (1.26, 2.89) | |||
| 15 | Roozen et al. [42] | South Africa | 07/16–11/17 | 394 (73) | 264 (67) | 39.8 | SBP > 130 mmHg, DBP > 85mmHg or use of antihypertensive medication | 101 (35.1) | 20 (18.9) | 2.32 (1.35, 4.00) | ||||||
| 16 | Msoka et al. [43] | Tanzania | 104 (62) | 74 (71) | 54.6 | Blood pressure equal to or greater than 140/90 mmHg | 14 (21.9) | 6 (15.0) | 1.59 (0.55, 4.54) | |||||||
| Outcome = Chronic kidney disease | ||||||||||||||||
| 23 | Cailhol et al. [50] | Burundi | 2/08–2/09 | 238 (72) | 211 (70) | 40.1 | GFRCG < 60 ml/min or GFRMDRD < 60 ml/min/1.73 m2 and/or kidney damage defined as a urinary abnormality at any GFR level | 7 (4) | 8 (12) | 0.31 (0.11, 0.91) | ||||||
| 24 | Sarfo et al. [51] | Ghana | 05/10–01/11 | 238 (61) | 172 (72) | 39.2d | CrCl < 60 ml/min/1.73m2 (Cockroft-Gault) or proteinuria ≥ 1 (confirmed by uPCR > 45 mg/mmol) on urinalysis | 22 (15) | 41 (44) | 3.63 (1.67, 7.91) | ||||||
| 3 | Peck et al. [31] | Tanzania | 10/12–04/13 | 301 (50) | 204 (68) | 38.5d | eGFR < 60 ml/minute and/or microalbuminuria according to KDIGO | 62 (41) | 52 (34) | 1.34 (0.84, 2.14) | ||||||
| 12 | Sarfo et al. [39] | Ghana | 451 (55) | 367 (81) | 44.5 | eGFR < 60 ml/minute | 6 (2) | 6 (3) | 0.80 (0.25, 2.52) | |||||||
| 25 | Che Awah Nforbugwe et al. [52] | Cameroon | 3/16–6/16 | 136 (50) | 100 (72) | 39.5 | CrCl < 60 ml/min/1.73 m2 | 18 (27) | 8 (12) | 2.7 (1.08, 6.73) | ||||||
| 26 | Sulaimain et al. [53] | Nigeria | 01/12–12/14 | 400 (50) | 276 (69) | 36.6 | eGFR < 60 ml/minute | 21 (10.5) | 61 (30.5) | 0.27 (0.16, 0.46) | ||||||
| Outcome = Cardiovascular disease | ||||||||||||||||
| 10 | Achwoka et al. [37] | Kenya | 10/15–09/16 | 3170 (68) | 2115 (67) | Documented record of hypertension, heart attack, or stroke in medical records | 322 (15) | 25 (3) | 6.80 (4.49, 10.28) | |||||||
SBP systolic blood pressure, DBP diastolic blood pressure, OGTT oral glucose tolerance test, KDIGO Kidney Disease Improvement Global Outcomes
*Imperial to metric units conversions: 7 mmol/l = 126 mg/dl; 11.1 mmol/l = 200 mg/dl
aOdds ratios represent odds of NCD diagnosis by ART status
bOdds ratio as reported in primary paper, adjusted for age, sex, study site, and educational status
cOdds ratio as reported in primary paper, adjusted for age, gender, family history of hypertension, smoking, and obesity
dMedian age reported