Clinical similarities and differences between two large HIV cohorts in the United States and Africa

Anne K. Monroe, Department of Epidemiology and Biostatistics, Milken Institute School of Public Health at the George Washington University, Washington DC, United States of America.
Christina S. Polyak, U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America.
Amanda D. Castel, Department of Epidemiology and Biostatistics, Milken Institute School of Public Health at the George Washington University, Washington DC, United States of America.
Allahna L. Esber, U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America.
Morgan E. Byrne, Department of Epidemiology and Biostatistics, Milken Institute School of Public Health at the George Washington University, Washington DC, United States of America.
Jonah Maswai, U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America.
John Owuoth, U.S. Army Medical Research Directorate - Africa, Kisumu, Kenya.
Lucas Maganga, National Institute for Medical Research - Mbeya Medical Research Centre, Mbeya, Tanzania.
Emmanuel Bahemana, U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America.
Yakubu Adamu, U.S. Army Medical Research Directorate - Africa, Abuja, Nigeria.
Michael Iroezindu, U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America.
Hannah Kibuuka, Makerere University-Walter Reed Project, Kampala, Uganda.
Francis Kiweewa, Makerere University-Walter Reed Project, Kampala, Uganda.
Alan E. Greenberg, Department of Epidemiology and Biostatistics, Milken Institute School of Public Health at the George Washington University, Washington DC, United States of America.
Trevor A. Crowell, U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America.
Julie A. Ake, U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America.

Document Type

Journal Article

Publication Date

1-1-2022

Journal

PloS one

Volume

17

Issue

4

DOI

10.1371/journal.pone.0262204

Abstract

BACKGROUND: 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.

Department

Epidemiology

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