- Non Communicable Disease part 1
- Noncommunicable diseases and their risk factors
- Communicable and non-communicable diseases: connections, synergies and benefits of integrating care
- Noncommunicable diseases country profiles 2018
- Heads of State commit to lead response to beat noncommunicable diseases, promote mental health
- Peace Corps
There is a growing association between communicable and non-communicable diseases in low- and high-income countries and amongst the rich and the poor.
Recent global data show that every year about 1. Most of this mortality is premature. ART is also the most important strategy for reducing mortality in HIV-infected patients with TB, with its impact strengthened by concomitant use of cotrimoxazole and attention to the prevention, diagnosis and treatment of other opportunistic infections. At the same time, PLHIV are also at increased risk of premature cardiovascular disease due to a higher prevalence of traditional risk factors such as smoking, alcohol and substance abuse, adverse effects of certain antiretroviral ARV drugs such as abacavir and some protease inhibitors and the direct effects of HIV itself.
In HIV-infected persons, whether they are on ART or not, there is chronic activation of the innate immune system with excessive production of inflammatory markers that in turn are associated with an increased risk of atherosclerosis, coronary artery inflammation and all-cause mortality.
There is convincing evidence, for example, in Europe and North America, that smoking reduces the life expectancy in PLHIV on ART, 6 which suggests that smoking cessation interventions could have an important impact in improving longer-term outcomes. In a North American cohort of PLHIV, attention to lipid-lowering and anti-hypertension therapy combined with more lipid-friendly and less toxic ARV drugs has been shown to significantly reduce the risk of myocardial infarction, 7 suggesting the importance of including such interventions in the care package of PLHIV.
In another example, there are important associations between DM and TB.
Non Communicable Disease part 1
DM, both type 1 and type 2, increases the risk of TB by a factor of two or three, and estimates put the number of adult TB cases associated with DM at just over one million. Bi-directional screening and integrated management should help to improve early diagnosis, treatment and health outcomes of both conditions. There is preliminary evidence to suggest that metformin in its own right is a promising host-adjunctive therapy for TB, with studies showing in vitro action against Mycobacterium tuberculosis and in vivo activity in controlling tuberculous infection and modifying disease severity.
The oft-quoted comments that TB and ART clinics are too busy to take on the additional tasks around non-communicable diseases or that clinics for non-communicable diseases do not understand or want to take on public health screening for infectious diseases must be acknowledged.
However, maintaining the status quo will not help reduce the huge burden of premature mortality or unlock the potential improvements in outcomes of integrated care. Operational research or implementation science would help to pave the way forward by testing whether, for example, screening all PLHIV or TB patients for blood pressure or fasting blood glucose, respectively, is feasible and cost-effective or whether such screening should be targeted at certain individuals based on age, body mass index or smoking status.
Depending on context, other non-communicable diseases such as cervical cancer, renal disease and mental illness could also be considered. To date, direct evidence of the benefits of integrated services remains scarce and this needs to change. Communicable and non-communicable diseases occur within the same patient populations, and it is vital to secure the necessary political and programmatic commitment for integrated, effective and sustainable action to address them.
Noncommunicable diseases and their risk factors
This in turn will help achieve the goal of healthy lives and wellbeing for all. Conflicts of interest: none declared. National Center for Biotechnology Information , U. Journal List Public Health Action v. Public Health Action. Published online Sep Harries , 1, 2 A.
Kumar , 3 S. Satyanarayana , 3 Y.
Takarinda , 1, 5 H. Tweya , 1, 6 A. Reid , 7 and R.
Zachariah 7. Author information Article notes Copyright and License information Disclaimer. Corresponding author.
Received Jun 9; Accepted Jul This article has been cited by other articles in PMC. Footnotes Conflicts of interest: none declared. References 1.
Communicable and non-communicable diseases: connections, synergies and benefits of integrating care
Antiretroviral therapy for prevention of HIV-associated tuberculosis in developing countries: a systematic review and meta-analysis. PLOS Med. HIV infection: epidemiology, pathogenesis, treatment, and prevention.
An ambitious treatment target to help end the AIDS epidemic. Persistent immune activation in chronic HIV infection: do any interventions work?
Declining relative risk for myocardial infarction among HIV-positive compared with HIV-negative individuals with access to care. Clin Infect Dis.
Noncommunicable diseases country profiles 2018
Improving tuberculosis prevention and care through addressing the global diabetes epidemic: from evidence to policy and practice. Lancet Diabetes Endocrinol. The impact of diabetes on tuberculosis treatment outcomes: a systematic review.
BMC Med. Association of diabetes and tuberculosis: impact on treatment and post-treatment outcomes.
Heads of State commit to lead response to beat noncommunicable diseases, promote mental health
Collaborative framework for care and control of tuberculosis and diabetes. Geneva, Switzerland: WHO; Metformin as adjunct antituberculosis therapy. Sci Transl Med. Glass R I. J Acquir Immune Defic Syndr.
HIV, tuberculosis, and noncommunicable diseases: what is known about the costs, effects, and cost-effectiveness of integrated care? Support Center Support Center.