Cardiometabolic disease risk and HIV status in rural South Africa: establishing a baseline

Abstract

BackgroundTo inform health care and training, resource and research priorities, it is essential to establish how non-communicable disease risk factors vary by HIV-status in high HIV burden areas; and whether long-term anti-retroviral therapy (ART) plays a modifying role.MethodsAs part of a cohort initiation, we conducted a baseline HIV/cardiometabolic risk factor survey in 2010–2011 using an age-sex stratified random sample of ages 15+ in rural South Africa. We modelled cardiometabolic risk factors and their associations by HIV-status and self-reported ART status for ages 18+ using sex-stratified logistic regression models.ResultsAge-standardised HIV prevalence in women was 26% (95% CI 24-28%) and 19% (95% CI 17–21) in men. People with untreated HIV were less likely to have a high waist circumference in both women (OR 0.67; 95% CI 0.52-0.86) and men (OR 0.42; 95% CI 0.22-0.82). Untreated women were more likely to have low HDL and LDL, and treated women high triglycerides. Cardiometabolic risk factors increased with age except low HDL. The prevalence of hypertension was high (40% in women; 30% in men).ConclusionsSub-Saharan Africa is facing intersecting epidemics of HIV and hypertension. In this setting, around half the adult population require long-term care for at least one of HIV, hypertension or diabetes. Together with the adverse effects that HIV and its treatment have on lipids, this may have serious implications for the South African health care system. Monitoring of the interaction of HIV, ART use, and cardiometabolic disease is needed at both individual and population levels.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1467-1) contains supplementary material, which is available to authorized users.

HIV treatment is associated with a twofold higher probability of raised triglycerides: pooled analyses in 21 023 individuals in sub-Saharan Africa

“…Our findings are broadly consistent with earlier reports, including a study among black African women in rural South Africa and a meta-analysis of clinical trials in European-descent populations [31,32]. These studies suggested that first-line ART is associated with raised cholesterol and TG [31,32].…”

“…These studies suggested that first-line ART is associated with raised cholesterol and TG [31,32]. In addition, a study of metabolic complications in a European-descent population found that the use of combined NNRTI and PI was associated with a fivefold higher prevalence of hypertriglyceridaemia [33].…”

Sociodemographic, socioeconomic, clinical and behavioural predictors of body mass index vary by sex in rural South African adults-findings from the AWI-Gen study

“…Previous studies in this rural population have reported higher BMIs in females, with an age-adjusted prevalence of obesity of 26% in females aged 15 and older compared to 7% in similarly aged males [17] and a 24.6% higher prevalence of obesity in females in those over 50 years [18]. Similar differences were evident in rural Ghana where the prevalence of obesity in women was seven times that in men [24].…”

“…Individuals who had previously participated in earlier studies investigating the interaction between HIV and NCDs [17,18] were invited to participate and, to supplement this group, a random sample of individuals aged 40–60 years was drawn from the 2013 Agincourt HDSS database. The sample was stratified by sex to achieve equal numbers of males and females.…”

Genomic and environmental risk factors for cardiometabolic diseases in Africa: methods used for Phase 1 of the AWI-Gen population cross-sectional study

“…Some of these individuals had participated in earlier studies, and their participation here allowed for longitudinal analysis of CMD risk factors [35,36]. The questionnaire administered to participants only included questions not already included in the HAALSI study.…”