HIV, antiretroviral therapy and non‐communicable diseases in sub‐Saharan Africa: empirical evidence from 44 countries over the period 2000 to 2016

Abstract

Introduction The HIV‐infected population is growing due to the increased accessibility of antiretroviral therapy (ART) that extends the lifespan of people living with HIV (PLHIV). We aimed to assess whether national HIV prevalence and ART use are associated with an increased prevalence of cardiovascular risk factors. Methods Using country‐level data, we analysed the effect of HIV prevalence and use of ART on cardiovascular risk factors in 44 countries in sub‐Saharan Africa between 2000 and 2016. We used fixed‐effects estimation to quantify the effect of HIV and ART on the prevalence of diabetes, mean body mass index, the prevalence of overweight, obesity and hypertension, and mean systolic blood pressure. The models were adjusted for calendar time, the age structure of the population, income and education. Results Diabetes prevalence among PLHIV was 5.8 percentage points higher (95% confidence interval (CI) 1.8 pp to 9.8 pp) compared to individuals without HIV. People receiving ART had a 4.6 percentage point higher prevalence (95% CI 2.6 pp to 6.6 pp). The prevalence of obesity was increased by 14.7 percentage points (95% CI 2.5 pp to 26.9 pp) for PLHIV. Receiving ART was associated with an increased obesity prevalence by 14.0 percentage points (95% CI 4.8 pp to 23.2 pp), whereas it had no significant association with the prevalence of overweight. The population aged 40 to 59 had a significantly higher prevalence of diabetes, overweight and obesity. HIV prevalence and ART use had no significant association with the prevalence of hypertension. Conclusions An ageing HIV‐infected population on ART is associated with a significant increase in the prevalence of diabetes and obesity in sub‐Saharan Africa. The increasing prevalence of these cardiovascular risk factors emphasizes the need for comprehensive healthcare programmes that screen and treat both HIV and non‐communicable diseases to decrease the associated morbidity and mortality rates.

Hypertension Care Cascade at a Large Urban HIV Clinic in Uganda: A Mixed Methods Study Using the Capability, Opportunity, Motivation for Behavior Change (COM-B) Model

“…Our ndings complement growing literature that supports integration of care for NCDs like HTN within existing HIV services by leveraging the huge gains attained by HIV programs [13][14][15][16][17]. Both PLHIV and healthcare providers expressed interest in integrated HTN/HIV care.…”

“…To preserve the gains made in HIV care, the treatment cascade must now be extended to include integration of care for HTN within existing HIV services for dual HTN and HIV control [13][14][15][16][17]. A multicenter trial in rural Uganda demonstrated that an integrated HTN/HIV care model that leverages the HIV infrastructure is preferable to vertical programs for both conditions [16].…”

High prevalence of non-communicable diseases among key populations enrolled at a large HIV prevention & treatment program in Kenya

“…systematic reviews outside SSA suggest that sexual minorities exhibit higher rates of NCDs [11]. Contrastingly, study findings from SSA point to comparably lower prevalence rates of NCDs (4.7%, 11.5% and 21.2%) among general population PLHIV clients [5,13,23,24].…”

“…pressure readings [28,29], several others point to an increased prevalence of hypertension and obesity [5,7,30]. There are mixed associations with ART use on the prevalence of NCDs with some studies suggesting no associations with hypertension [23,31] while others finding an increased odds for hypertension, dyslipidemia and other cardiovascular conditions [29,30,32]. Although chronic immune activation contributes to increased hypertension among PLHIV, the inflammatory milieu is poorly understood [33].…”

Review of Ongoing Activities and Challenges to Improve the Care of Patients With Type 2 Diabetes Across Africa and the Implications for the Future

“…Other potential factors impacting on key issues such as adherence include concomitant co-morbidities such as infectious diseases appreciably increasing the pill burden and regimen complexity (Libby et al, 2013). Treatments for HIV can themselves also lead to weight gain and obesity further complicating the management of T2DM patients with HIV (Bailey et al, 2016;Pastakia et al, 2017;Kumar and Samaras, 2018;Coetzee et al, 2019;Venter et al, 2019). A study undertaken in an HIV clinic in South Africa found the metabolic syndrome was seen in 20% of cases within 1 year after initiation of anti-retroviral treatment (ART) despite the young age of patients, presumably as a consequence of ART exposure (Julius et al, 2011).…”