Over the last decade, the Kenyan national HIV treatment program has grown exponentially, with improved survival among people living with HIV (PLHIV). In the same period, noncommunicable diseases (NCDs) have become a leading contributor to disease burden in the country. There is limited data on the burden of NCDs among PLHIV in Kenya. We sought to characterize the burden of four major categories of NCDs (cardiovascular diseases, cancer, chronic respiratory diseases and diabetes mellitus) among adult PLHIV in Kenya.
We conducted a nationally representative retrospective medical chart review of HIV-infected adults aged ≥15 years enrolled in HIV care and treatment facilities in Kenya from October 1, 2003 through September 30, 2013. We estimated proportions of the four NCD categories among PLHIV at enrollment into HIV care, and occurrence and management during subsequent HIV care and treatment visits. We compared proportions and assessed distributions of co-morbidities using the Wald adjusted Pearson’s χ-square test. We calculated NCD incidence rates and their jackknife confidence intervals in assessing cofactors for developing NCDs.
We analyzed 3170 patient records; 2115 (66.3%) were from women. Slightly over half (51.1%) of patient records were from PLHIVs aged above 35 years. Close to two-thirds (63.9%) of PLHIVs were on ART. The proportion of any documented NCD among PLHIV was 11.5% (95% confidence interval [CI] 9.3, 14.1), with elevated blood pressure as the most common NCD (87.5%) among PLHIV with diagnosed NCD. Although serial elevated blood pressures were detected among 343 patients, only 17 had a documented diagnosis of hypertension in their medical record. The differences in overall NCD incidence rates for men and women were not statistically significant (42.3 per 1000 person years [95% CI 35.8, 50.1] and 31.6 [95% CI 27.7, 36.1], respectively). No differences in NCD incidence rates were seen by marital or employment status. At one year of follow up 43.8% of PLHIV not on ART had been diagnosed with an NCD compared to 3.7% of patients on ART; at five years the proportions with a diagnosed NCD were 88.8% and 39.2% (p<0.001), respectively.
PLHIV in Kenya have a high incidence of NCD diagnoses. In the absence of systematic screening, NCD incidence is likely underestimated in this population. In context of a rising national burden of NCDs and increased survival among PLHIV, Kenya should consider increasing investment in integrated HIV-NCD screening and care.