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

Human Immunodeficiency Virus (HIV) and tuberculosis (TB) continue to pose a significant health burden in Kenya. Countries with the highest rates of people living with HIV (PLWH) also have a high prevalence of non-communicable diseases (NCDs), including type 2 diabetes (T2D) and hypertension (HPT). This study evaluated the burden and factors associated with T2D, HPT, and TB, including resistant strains among PLWH receiving antiretroviral therapy (ART) in Eastern Kenya. Blood and sputum samples, and baseline information were collected from 280 consenting PLWH. The participants' blood pressure (BP), glycated hemoglobin (HbA1c), CD4 cell counts, HIV viral load, full blood count, blood chemistry, and Rifampicin resistance were assessed. The mean (SD) age of the participants was 35.6 (±9.8) years, and a median (IQR) duration of living with HIV of 7 (4 -8) years. Most participants, 179 (63.9%), were HIV mono-infected, with 58 (20.7%) HIV/TB, 42 (15%) HIV/T2D, and 33 (11.8%) HIV/HPT dual comorbidities reported. Triple comorbidities reported included 18 (6.4%) HIV/T2D/HPT, 9 (3.2%) HIV/TB/T2D, and 9 (3.2%) HIV/TB/HPT, with 4 (1.4%) HIV/TB/T2D/HPT quadruple comorbidity reported. Six (2.1%) multidrug-resistant TB coinfections were detected. In multivariate analyses, being on ARV only (aOR 0.5; 95% CI 0.4 - 0.6, p = 0.0001) and achieving virological suppression (aOR 0.8; 95% CI 0.6 - 0.9, p = 0.017) were protective against HIV/TB coinfection. Previous 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. The PLWH in Eastern Kenya continues to experience a syndemic of NCDs and TB, including resistant strains. Consistent adherence to ART is crucial for achieving viral suppression; these are protective against NCDs and TB among PLWH. The findings highlight the necessity of integrating NCD management with HIV and TB treatment programs in Kenya.