NCDs at the CORE Group: HIV Treatment and Cardiovascular Disease

Charlotte Block of Project Hope organized a session on May 12 at the CORE Group in Baltimore on "Non Communicable Diseases (NCDs) -- The Unheralded Global Epidemic."  In addition to Ms. Block, who spoke on the global reach of diabetes, the session also featured presentations by Dr. Vivien Tsu of PATH on cancers (cervical and breast) as development issues, and Dr. Inoussa Kabore of FHI, who described his organization's programs to address cardiovascular disease in the context of HIV/AIDS treatment. I moderated the session and gave an overview of the epidemic, and plans for a UN High Level Session on NCDs later this year.


Kabore spoke about several pilots that FHI is doing in Kenya, Nigeria and Vietnam to demonstrate the economy and efficiency of managing patients needs for both anti-retroviral therapy (ART) of HIV/AIDS and cardiovascular screening.  Kenya is of great interest, according to Dr. Kabore, in particular because of the rising tide of NCDs is already showing up there in the general population.  According to the World Health Organization's (WHO) newly-published 2010 Global Status Report on NCDs, in 2008, more than 103,000 Kenyans probably died from NCDs, and cardiovascular disease and diabetes make up the largest percentage of those.  Although there were no national-level data as of that year, the WHO report also estimates that 37 percent had elevated blood pressure readings or were already taking blood pressure medication.  


In the course of his presentation, Dr. Kabore mentioned that preliminary results from his study in Kenya of more than 4,000 clinic patients has reconfirmed earlier studies showing that long-term use of first-line ARTs puts patients at greater risk for high blood pressure and cardiovascular disease. Kabore said that the study is still underway, and so data -- including on whether ART recipients are also at risk of developing higher than normal blood lipid levels -- are being compiled for better analysis and potential publication.  But he noted that "the link between HIV/AIDS treatment and higher blood pressure is clear."  He said the effects were especially pronounced in those who had been on ARTs the longest.


The connection between ARTs and elevated blood pressure represents yet another clear linkage between infectious and chronic diseases, and a further reason why those in the HIV/AIDS field might want to take note of the rising toll from NCDs. The President's Emergency Plan for HIV/AIDS Relief (PEPFAR) as of September 30, 2009,  "directly supported life-saving ART for over 2.4 million men, women and children. They represent more than half of the estimated four million individuals in low and middle-income countries on treatment." As millions of patients survive today thanks to life saving ART, it would seem to make sense for programs like PEPFAR and the President's Global Health Initiative to also pay attention to the heart-healthy status of these patients, to make sure that they survive not just the scourge of HIV, but also the silent epidemic of cardiovascular disease, including heart attack and stroke. 



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