Non-communicable disease outcomes among adults living with HIV in Asia

The introduction of effective antiretroviral therapy (ART) has dramatically increased life expectancy of people living with HIV (PLHIV). However, due to lifestyle factors, side effects of ART, ongoing inflammation and immune activation, and ageing, non-communicable diseases (NCDs) are becoming more apparent in this population. This will prove challenging in some countries in the Asian region, where health systems are already strained by a high HIV burden and limited resources are available to provide optimal care for all PLHIV. The aim of this thesis was to investigate NCDs – primarily cardiovascular disease (CVD), diabetes and kidney disease – and related outcomes in PLHIV in the Asian region. All analyses were based on routinely collected data from the TREAT Asia cohorts, two large adult observational cohorts of PLHIV in 12 countries across the Asia-Pacific region. Similar to what is happening at the global level, ART uptake across this region has increased over time. Among those on ART in the TREAT Asia cohorts, there was a considerable burden of comorbid CVD, diabetes and kidney disease. Risk factors for CVD were primarily of modifiable nature, such as hypertension, unfavourable lipid levels and overweight. It was estimated that the CVD incidence might double in the next decade, although this could be largely addressed by implementing interventions that target CVD risk factors. Diabetes and prediabetes were strongly associated with mortality. When assessing risk factors of mortality after long-term exposure to ART, the findings showed that diabetes, kidney disease, and hepatitis were associated with increased mortality, while treatment continuity remained important to improve survival. Overall, the findings indicate that there was suboptimal monitoring for NCDs in the TREAT Asia cohorts.With the growing population of PLHIV who are on life-long ART, there is an urgent need for integrated NCD and HIV care. Timely interventions are key to reducing the unnecessary morbidity and mortality. Future efforts to improve NCD-related outcomes in PLHIV in the Asian region should thus have a clear focus on screening and monitoring for NCDs with appropriate diagnostic tools and access to affordable treatment options