Cancers, heart disease, chronic lung disease, diabetes, and chronic kidney diseaseâ€”non-communicable diseases (NCDs) are now the biggest cause of death worldwide, not just in rich industrialised countries but also in low to middle income countries such as Malawi.
People with HIV infection are at increased risk of NCDs; first, from the HIV infection itself; second, from antiretroviral treatments; and third, from the risk associated with increasing age because many NCDs increase in frequency as people age.
HIV also causes inflammation and many researchers are now trying to understand what effect this process has on the risk of developing a wide-range of non-communicable diseases. Several of the opportunistic illnesses associated with HIV infection are NCDs in their own right, such as HIV-associated lymphoma, cervical cancer and others.
One study in Kenya demonstrated that, when people were screened for both HIV infection and NCDs, HIV positive people had significantly higher rates of hypertension than those who were HIV negative. More than one third of the people who came for HIV testing had elevated blood pressure, and one quarter were obese. Nevertheless, the benefits of ART far outweigh the risk of NCDs or chronic complications.
The risk of TB in people with diabetes is significant; hence, the World Health Organisation production of a framework on TB and diabetes care and control. Diabetes and TB have an intricate relationship: People with diabetes are around three times more likely to develop TB, people with diabetes take longer to respond to TB treatment, diabetics with well-controlled blood sugar are less likely to develop TB. The WHO policy recommends coordination, surveillance and monitoring and evaluation of both diabetes and TB at healthcare facilities.
NCDs can be addressed both by care and prevention. Measures to reduce smoking, salt and alcohol intake, together with promotion of exercise and weight loss, and treatment of risk factors for heart disease, are priorities for prevention. These strategies can counteract heart disease, diabetes, cancer and other chronic diseases.
Researchers are also suggesting that NCD prevention and care should be integrated with HIV care in much the same way as TB screening is. Discussions are ongoing at policy and research levels around the world on the lessons that can be learnt from the rapid scale up of HIV care, treatment and prevention services in the context of improving NCD health services.- (Adapted from HIV and TB in Practice for nurses: non-communicable diseases, by Theo Smart)