Clinical similarities and differences between two large HIV cohorts in the United States and Africa
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Date
2022
Journal Title
Journal ISSN
Volume Title
Publisher
Plos one
Abstract
Washington, DC, and sub-Saharan Africa are both affected by generalized HIV epidemics.
However, care for persons living with HIV (PLWH) and clinical outcomes may differ in these
geographically and culturally diverse areas. We compared patient and clinical site characteristics
among adult persons living with HIV (PLWH) enrolled in two longitudinal HIV cohort
studies—the African Cohort Study (AFRICOS) and the DC Cohort.
Methods
The DC Cohort is a clinic-based city-wide longitudinal cohort comprised of PLWH attending
15 HIV clinics in Washington, DC. Patients’ socio-demographic characteristics, clinical evaluations,
and laboratory data are retrospectively collected from electronic medical records
and limited manual chart abstraction. AFRICOS is a prospective observational cohort of
PLWH and uninfected volunteers attending 12 select HIV care and treatment facilities in
Nigeria, Kenya, Uganda and Tanzania. AFRICOS study participants are a subset of clinic
patients who complete protocol-specific visits every 6 months with history and physical
examination, questionnaire administration, and blood/sputum collection for ascertainment
of HIV outcomes and comorbidities, and neurocognitive and functional assessments.
Among participants aged 18 years, we generated descriptive statistics for demographic and clinical characteristics at enrollment and follow up and compared them using bivariable
analyses.
Results
The study sample included 2,774 AFRICOS and 8,420 DC Cohort participants who enrolled
from January 2013 (AFRICOS)/January 2011 (DC Cohort) through March 2018. AFRICOS
participants were significantly more likely to be women (58.8% vs 27.1%) and younger
(83.3% vs 61.1% aged < 50 years old) and significantly less likely to be MSM (only 0.1% of
AFRICOS population reported MSM risk factor) than DC Cohort. Similar rates of current
viral suppression (about 75% of both samples), hypertension, hepatitis B coinfection and
alcohol use were observed. However, AFRICOS participants had significantly higher rates
of CD4<200 and tuberculosis and significantly lower rates of obesity, DM, hepatitis C coinfection
and syphilis.
Conclusions
With similar viral suppression outcomes, but many differences between our cohorts noted,
the combined sample provides unique opportunities to assess and compare HIV care and
treatment outcomes in the U.S. and sub-Saharan Africa. Comparing these two cohorts may
inform care and treatment practices and may pave the way for future pathophysiologic
analyses.
Description
Keywords
Clinical similarities, HIV cohorts, United States, Africa
Citation
Monroe AK, Polyak CS, Castel AD, Esber AL, Byrne ME, Maswai J, et al. (2022) Clinical similarities and differences between two large HIV cohorts in the United States and Africa. PLoS ONE 17(4): e0262204. https://doi.org/10.1371/journal. pone.0262204