Despite improved life expectancy with antiretroviral therapy (ART), persons living with HIV (PLWH) have higher rates of noninfectious comorbid diseases (NCDs) than do uninfected individuals. Chronic inflammation and immune activation due to persistent low-level viral replication may contribute to the heightened risk of NCDs among some PLWH. We characterized the risk of several NCDs among PLWH with undetectable plasma viral load, persistent low-level viremia (pLLV), and viral failure in the African Cohort Study (AFRICOS).
AFRICOS is an ongoing cohort enrolling participants in 12 clinics in Uganda, Kenya, Tanzania, and Nigeria. Clinical assessments, including HIV viral load testing, are completed every six months. Participants without an NCD at baseline were included in these time-to-event analyses. PLLV was defined as at least two consecutive visits with a detectable viral load <1000 copies/mL. We examined four different NCDs: elevated blood pressure (any single systolic pressure >139, diastolic >89 mmHg, or use of anti-hypertensive medications), hypercholesterolemia (total cholesterol >199 mg/dL or lipid-lowering medications), dysglycemia (any non-fasting glucose >199 mg/dL or fasting glucose >99 mg/dL), and renal insufficiency (estimated glomerular filtration rate <60). We also evaluated the presence of any one or more of these NCDs as a dichotomized outcome variable. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazard modeling. Models were adjusted for study site, education, ART regimen, and age.
As of June 1, 2019, 2,872 PLWH were enrolled of which 1,773 did not have an NCD at baseline and were included in these analyses. The majority of participants were female (58%) and between 18-39 years (61%) with 12% >50 years at enrollment. Over the course of follow up, 623 (35%) participants developed any NCD, including 261 (15%) who developed elevated blood pressure, 359 (20%) hypercholesterolemia, 176 (10%) dysglycemia, and 28 (2%) renal insufficiency. Participants with pLLV developed any NCD sooner than their virally-suppressed counterparts (HR 1.49 [95% CI 1.24-1.80]). Similar associations were observed for most of the individual NCDs evaluated (Table).
PLLV was significantly associated with NCDs in this population. Targeting viral suppression below the limit of detection on clinical HIV viral load assays may reduce the risk of non-infectious complications of HIV.