Metabolic syndrome among treatment‐naïve people living with and without HIV in Zambia and Zimbabwe: a cross‐sectional analysis

Abstract

Introduction Chronic viral replication has been linked to an increased risk of cardiovascular and metabolic diseases in people living with HIV (PLWH), but few studies have evaluated this association in Southern Africa. We explored the determinants of metabolic syndrome (MetS) among treatment‐naïve adults living with and without HIV in Southern Africa. Methods Treatment‐naïve PLWH and people living without HIV (PLWOH) ≥30 years were consecutively enrolled from primary care clinics in Zambia and Zimbabwe. PLWOH were seronegative partners or persons presenting for HIV testing. We defined MetS as the presence of central obesity plus any two of the following: raised blood pressure, impaired fasting glucose, reduced high‐density lipoprotein cholesterol and raised triglycerides, as defined by the International Diabetes Federation. We used logistic regression to determine factors associated with MetS. Results Between August 2019 and March 2022, we screened 1285 adults and enrolled 420 (47%) PLWH and 481 (53%) PLWOH. The median age was similar between PLWH and PLWOH (40 vs. 38 years, p < 0.24). In PLWH, the median CD4 + count was 228 cells/mm 3 (IQR 108–412) and the viral load was 24,114 copies/ml (IQR 277–214,271). Central obesity was present in 365/523 (70%) females and 57/378 males (15%). MetS was diagnosed in 172/901 (19%, 95% confidence interval [CI] 17–22%), and prevalence was higher among females than males (27% vs. 9%). In multivariable analyses, HIV status was not associated with MetS (adjusted odds ratio [aOR] 1.05, 95% CI 0.74–1.51). Risk factors for MetS included age older than 50 years (aOR 2.31, 95% CI 1.49–3.59), female sex (aOR 3.47, 95% CI 2.15–5.60), highest income (aOR 2.19, 95% CI 1.39–3.44) and less than World Health Organization recommended weekly physical activity (aOR 3.35, 95% CI 1.41–7.96). Conclusions We report a high prevalence of MetS and central obesity among females in urban Zambia and Zimbabwe. Lifestyle factors and older age appear to be the strongest predictors of MetS in our population, with no evident difference in MetS prevalence between treatment‐naïve PLWH and PLWOH.

Prevalence of metabolic syndrome among people living with human immunodeficiency virus in sub-Saharan Africa: a systematic review and meta-analysis

“…Among the 25 included studies, eight were from Ethiopia 21 – 28 , six were from South Africa 29 – 34 , three were from Nigeria 35 – 37 , two were from Kenya 38 , 39 , two were from Zambia 40 , 41 , and one each was from Cameroon 42 , Uganda 43 , Botswana 44 , and Zimbabwe 40 . The included study sample sizes ranged from 79 45 to 1108 41 , with a total of 8602 people living with HIV/AIDS.…”

The Social Construction of Aging Among a Clinic-Based Population and Their Healthcare Workers in Zambia

“…From November 2020 to July 2021, we conducted an exploratory qualitative study with participants from a Clinic and a 1st Level Hospital, both characterized by a high HIV burden (>10,000 PLWH) and enrolled in the International Epidemiology Databases to Evaluate AIDS collaboration in Southern Africa (IeDEA-SA) study [ 20 ]. Ethical approval was provided by the University of Zambia Biomedical Research Ethics Committee (UNZABREC)-approval number 011-04-19.…”