Rising diabetes, hypertension and drug-resistant TB among people with HIV in Eastern Kenya

Kenya continues to struggle with overlapping health threats, and a new study led by Musa Otieno Ngayo describes how non-communicable diseases and tuberculosis are combining with HIV to create heavier burdens for patients in Eastern Kenya. The research focused on people living with HIV (PLWH) who were receiving antiretroviral therapy (ART), aiming to measure how common type 2 diabetes (T2D), hypertension (HPT) and tuberculosis (TB) are in this group, and to identify factors that predict these coinfections. The team enrolled 280 consenting PLWH, collected blood and sputum samples, and administered a detailed sociodemographic questionnaire. They also measured CD4 cell counts, plasma HIV-1 RNA, full blood cells and blood chemistry to place the infections and conditions in context. The group was relatively young, with a mean (SD) age of 35.6 (±9.8) years, and a median (IQR) duration living with of 7 (4 to 8) years. The abstract reports that 169 (82.4%) were on the first line ART regimen, and that the majority, 179 (63.9%), were HIV mono-infected, while many others carried one or more additional conditions.

The study used established laboratory tools and clear clinical thresholds to define disease. TB and rifampicin resistance was determined by Cepheid’s GeneXpert system while Glycated hemoglobin (HbA1c) was determined using SD A1cCare™ analyzer. Blood pressure (BP) measurements with systolic BP readings of≥140 mmHg and/or diastolic BP≥90 mmHg was considered hypertensive. From the 280 participants the researchers report dual coinfections as 58 (20.7%) HIV/TB, 42 (15%) HIV/T2D and 33 (11.8%) HIV/HPT. Triple coinfections included 18 (6.4%) HIV/T2D/HPT, 9 (3.2%) HIV/TB/T2D and 9 (3.2%) HIV/TB/HPT, with a quadruple coinfection of HIV/TB /T2 /HPT among 4 (1.4%) patients. Six 6 (2.1%) HIV patients were coinfected with multidrug resistant TB. In multivariable analysis, being on ARV only (aOR 0.5; 95% CI 0.4 – 0.6, p = 0.0001) and virological suppression (aOR 0.8; 95% CI 0.6 – 0.9, p = 0.017) were protective against HIV/TB coinfection. Previously hospital admission (aOR 1.2; 95% CI 1.1 – 1.4, p = 0.049) and previous TB infection (aOR 1.6; 95%CI 1.0 – 3.0, p = 0.034) were associated with greater likelihood of HIV/TB coinfection.

Taken together, the findings presented by Musa Otieno Ngayo and colleagues suggest that Eastern Kenya is facing a syndemic — a convergence of HIV, non-communicable diseases like type 2 diabetes and hypertension, and both drug-sensitive and drug-resistant TB. The presence of multidrug resistant TB among people living with HIV, even if numerically small in this sample, is particularly worrying because it complicates treatment and control efforts. The protective associations of ARV-only care and virological suppression highlight the value of effective HIV treatment in reducing the risk of TB, while the links with prior hospitalization and past TB point to vulnerable groups who may need closer follow-up. The authors conclude that these overlapping epidemics denote the need to integrate the management of NCDs among HIV and TB treatment programs in Kenya, to identify and treat comorbid conditions earlier and to adapt services so patients receive coordinated care for infections and chronic diseases.