Non communicable diseases and resistant tuberculosis, a growing burden among people living with HIV in Eastern Kenya

Human Immunodeficiency Virus (HIV) and tuberculosis (TB) still poses a significant health burden in Kenya. Countries with the highest burden of people living with HIV (PLWH) have a substantial burden of non-communicable diseases (NCDs) including type 2 diabetes (T2D) and hypertension (HPT). This study evaluated the burden and predictors of T2D, HPT and TB including resistant strains among PLWH receiving antiretroviral therapy (ART) in Eastern Kenya. Blood and sputum samples were obtained from 280 consenting PLWH and a detailed sociodemographic questionnaire was administered. 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. The participants CD4 cell counts, plasma HIV-1 RNA, full blood cells and blood chemistry were also measured. The patients mean (SD) age was 35.6 (±9.8) years, with 169 (82.4%) being on the first line ART regimen and a median (IQR) duration living with of 7 (4 to 8) years. The majority of the patients 179 (63.9%) were HIV mono-infected. The dual coinfections reported included; 58 (20.7%) HIV/TB, 42 (15%) HIV/ T2D, 33 (11.8%) HIV/HPT. Triple coinfections included; 18 (6.4%) HIV/T2D/HPT, 9(3.2%) HIV/TB/T2D, 9 (3.2%) HIV/TB/HPT with 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 the multivariable model, 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 to 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 HIV/TB coinfection. This study shows that Eastern Kenya is experiencing a syndemic of NCDs and TB including resistant strains among PLWH denoting the need to integrate the management of NCDs among HIV and TB treatment programs in Kenya.