UCLA

Objectives: Research from high-income countries (HICs) appeared to suggest that Human Immunodeficiency Virus (HIV) and antiretroviral therapy (ART) contribute to, alongside other well-established traditional risk factors, higher prevalence of non-communicable diseases (NCDs) such as diabetes and hypertension among people living with HIV (PLWH). Many of these chronic metabolic disorders are known to increase cardiovascular disease (CVD) risk, which can be assessed using available risk stratification models. However, in certain low- and middle-income countries (LMICs), such as Cambodia, the relationship between NCDs and CVD risk and HIV is generally under-studied. This is even more so for young people living with HIV (YLWH). Therefore, I examined the relationship between NCDs and HIV among Cambodian general population and PLWH including YLWH.

Design: Cross-sectional studies.

Methods: Chapter 2 and 3 used merged data from two surveys among PLWH (n=510) and the general population (n=2747), aged between 22-65+ years, conducted by KHANA Center for Population Health Research (nongovernmental organization) in 2015 and by the University of Health Sciences in 2016, respectively. Both employed a standardized questionnaire and physical/biochemical measurement protocols developed by the World Health Organization (STEPwise Approach to Surveillance or STEP survey or STEPS). Chapter 4 employed a STEP survey to gather information on 370 YLWH, aged 18-29 years, from three HIV clinics (known as Opportunistic Infections and Antiretroviral therapy or OI/ART clinics) in Phnom Penh. The information on the young general population was then obtained from the 2016 STEP survey. For each study, we computed NCD prevalence, plus CVD risk score based on the Framingham Risk Score (FRS) equations (study 2). We performed logistic regression to examine the relationship between NCDs and CVD risk and HIV while adjusting for age, sex, residence location, behavioral risk factors (such as smoking, heavy alcohol consumption, less than 5 servings of fruits and vegetables and low physical activity) and body mass index (BMI).

Results: Chapter 2 showed that the prevalence of hypertension and high cholesterolemia among adult PLWH were lower than that of the general population. However, the prevalence of diabetes and prediabetes was higher among PLWH; the odds of prediabetes, aOR=7.30 (95% CI: 5.69, 9.36), and of diabetes, aOR=1.46 (95% CI: 0.99, 2.17), were higher among PLWH than the general population. Next, chapter 3 showed that PLWH appeared to be as likely as the general population to have moderate-to-high (estimated) 10-year CVD risk, aOR=0.88 (95% CI: 0.60, 1.29). Finally, among YLWH (chapter 4), the prevalence of diabetes and hypertension is 4% (n=16) and 6% (n=22), respectively, among YLWH, compared to 1% (n=4) and 4% (n=22), among the general population of the same age group. We observed higher odds of diabetes/prediabetes among YLWH compared with the young general population, aOR=6.64 (95% CI: 3.62, 12.19). Additionally, YLWH were at much higher odds of high cholesterolemia, aOR=7.95 (95% CI: 3.98, 15.87), than the young general population.

Conclusion: To combat a future burden of NCDs and potentially their related morbidity and mortality, our studies underlined the need to set up essential intervention strategies, be it behavioral modification or medical intervention, in order to properly address these conditions among population living with HIV including YLWH. In addition to interventions, monitoring and screening efforts should also be put in place among this population given their susceptibility to develop these conditions at a younger age than the general population.