Population‐level decline in BMI and systolic blood pressure following mass HIV treatment: Evidence from rural KwaZulu‐Natal

Abstract

Objective: Clinic-based studies have shown that patients with human immunodeficiency virus (HIV) gain weight after initiation of antiretroviral therapy (ART). This study aimed to determine whether the scale-up of ART was associated with a population-level increase in body mass index (BMI) and blood pressure (BP) in a community with high HIV and obesity prevalence. Methods: A household survey was conducted in rural KwaZulu-Natal before ART scale-up (in 2004) and when ART coverage had reached 25% (in 2010). Anthropometric data was linked with HIV surveillance data. Results: Mean BMI decreased in women from 29.9 to 29.1 kg/m 2 (P 5 0.002) and in men from 24.2 to 23.0 kg/m 2 (P < 0.001). Similarly, overweight and obesity prevalence declined significantly in both sexes.Mean systolic BP decreased from 123.0 to 118.2 mm Hg (P < 0.001) among women and 128.4 to 123.2 mm Hg (P < 0Á001) among men.Conclusions: Large-scale ART provision is likely to have caused a decline in BMI at the population level, because ART has improved the survival of those with substantial HIV-related weight loss. The ART scaleup may have created an unexpected opportunity to sustain population-level weight loss in communities with high HIV and obesity prevalence though targeted lifestyle and nutrition interventions.

Noncommunicable diseases among HIV-infected persons in low-income and middle-income countries

“…HIV treatment is equally important in the prevention and management of NCDs among PLHIV [213,214]. Therefore, continued focus on test and treat with rapid viral suppression are necessary to improve HIV/NCD outcomes [213,214].…”

“…HIV treatment is equally important in the prevention and management of NCDs among PLHIV [213,214]. Therefore, continued focus on test and treat with rapid viral suppression are necessary to improve HIV/NCD outcomes [213,214]. Moreover, integration of NCD and HIV screening and management helps address challenges in controlling the HIV epidemic by providing access to otherwise hard-to-reach populations, such as adult men [215], by decreasing the risk for poor ART adherence, reducing the stigma of HIV, and strengthening health systems to evolve from providing acute care to providing preventive, chronic care.…”

The ART Advantage: Health Care Utilization for Diabetes and Hypertension in Rural South Africa

“…In particular, their lower BMI may be in part caused by their HIV disease and would be expected to reduce their risk of diabetes and hypertension, though they remain at heightened risk of other opportunistic infections. 4,30 …”

Blood pressure trajectories and the mediated effects of body mass index and HIV‐related inflammation in a mixed cohort of people with and without HIV in rural Uganda

“…There is evidence that untreated and early treated HIV is associated with weight loss and reduced BMI 17,18 and also that BMI is directly correlated with BP. 17 Therefore, BMI was treated as a mediator of the effect of HIV on BP and not a confounder as is in most analyses [18][19][20] to avoid collider stratification bias. 21 Observations were left-truncated at the dates of enrollment into the UGANDAC study (baseline date) and right-censored at the earli- [Corrections added on July 26, 2019, after first online publication: †p-values have each been moved up by one row, so that they now align with the row headings "Smoking," "Physical activity," and "Body mass index category"; ‡the entries have been moved one column to the right, so they now appear under the column heading "HIV-infected."]…”

“…We used a priori knowledge to select potential confounders that are postulated to affect the association between HIV and BP (Figure ) including age, gender, smoking, and physical activity. There is evidence that untreated and early treated HIV is associated with weight loss and reduced BMI and also that BMI is directly correlated with BP . Therefore, BMI was treated as a mediator of the effect of HIV on BP and not a confounder as is in most analyses to avoid collider stratification bias …”