Prevalence and predictors of uncontrolled hypertension, diabetes, and obesity among adults with HIV in northern Tanzania

ABSTRACT HIV is associated with increased risk of cardiovascular disease, but there has been less study of cardiovascular comorbidities among people with HIV in sub-Saharan Africa. In a cross-sectional observational study, Tanzanian adults presenting for outpatient HIV care completed a questionnaire and underwent weight, height, blood pressure, and blood glucose measurement. Hypertension was defined by blood pressure ≥140/90 mmHg or self-reported hypertension. Uncontrolled hypertension was defined as measured blood pressure ≥140/90 mmHg. Diabetes was defined by fasting glucose ≥126 mg/dl, random glucose ≥200 mg/dl, or self-reported diabetes. Obesity was defined by body mass index ≥30 kg/m2. Multivariate logistic regression was performed to identify predictors of uncontrolled hypertension. Among 500 participants, 173 (34.6%) had hypertension, 21 (4.2%) had diabetes, and 99 (19.8%) were obese. Of those with hypertension, 116 (67.1%) were unaware of their hypertension, and 155 (89.6%) had uncontrolled hypertension. In multivariate analysis, uncontrolled hypertension was associated with older age (OR 1.07, 95% CI: 1.05–1.10, p < 0.001) and higher body mass index (OR 1.17, 95% CI: 1.11–1.22, p < 0.001). Interventions are needed to improve screening and treatment for hypertension, diabetes, and obesity among Tanzanians with HIV.

[1]  A. Hill,et al.  Implications of weight gain with newer anti-retrovirals: 10-year predictions of cardiovascular disease and diabetes , 2021, AIDS.

[2]  P. Naidoo,et al.  Prevalence and predictors of diabetes mellitus among persons living with HIV: a retrospective cohort study conducted in 4 public healthcare facilities in KwaZulu-Natal , 2020, BMC Public Health.

[3]  C. Achenbach,et al.  Cardiovascular Anthropometry: What Is Best Suited for Large-Scale Population Screening in Sub-Saharan Africa? , 2020, Frontiers in Cardiovascular Medicine.

[4]  H. Mapesi,et al.  Rollout of dolutegravir-based antiretroviral therapy in sub-Saharan Africa and its public health implications , 2020, The Pan African medical journal.

[5]  J. Hertz,et al.  Hypertension burden and challenges across the hypertension treatment cascade among adults enrolled in HIV care in northern Tanzania , 2020, Journal of clinical hypertension.

[6]  Audrey Joyce Foka,et al.  Global burden of hypertension among people living with HIV in the era of increased life expectancy: a systematic review and meta-analysis. , 2020, Journal of hypertension.

[7]  Richard D Moore,et al.  Weight gain among treatment‐naïve persons with HIV starting integrase inhibitors compared to non‐nucleoside reverse transcriptase inhibitors or protease inhibitors in a large observational cohort in the United States and Canada , 2020, Journal of the International AIDS Society.

[8]  Temesgen Fiseha,et al.  Hypertension in HIV-Infected Patients Receiving Antiretroviral Therapy in Northeast Ethiopia , 2019, International journal of hypertension.

[9]  G. McComsey,et al.  Weight gain and integrase inhibitors. , 2019, Current opinion in infectious diseases.

[10]  F. Raal,et al.  Growth curve modelling to determine distinct BMI trajectory groups in HIV-positive adults on antiretroviral therapy in South Africa. , 2019, AIDS (London).

[11]  A. R. Akiteng,et al.  Integrated Hypertension and HIV Care Cascades in an HIV Treatment Program in Eastern Uganda: a retrospective cohort study. , 2019, Journal of acquired immune deficiency syndromes.

[12]  S. Vollmer,et al.  HIV, antiretroviral therapy and non‐communicable diseases in sub‐Saharan Africa: empirical evidence from 44 countries over the period 2000 to 2016 , 2019, Journal of the International AIDS Society.

[13]  M. Siedner,et al.  Validity of hemoglobin A1c for diagnosing diabetes among people with and without HIV in Uganda , 2019, International journal of STD & AIDS.

[14]  G. Yonga,et al.  Cardiovascular risk factors among people living with HIV in rural Kenya: a clinic-based study. , 2019, Cardiovascular journal of Africa.

[15]  S. Jaffar,et al.  Integrated care for human immunodeficiency virus, diabetes and hypertension in Africa. , 2018, Transactions of the Royal Society of Tropical Medicine and Hygiene.

[16]  S. Rajagopalan,et al.  Global Burden of Atherosclerotic Cardiovascular Disease in People Living With HIV: Systematic Review and Meta-Analysis , 2018, Circulation.

[17]  G. Bloomfield,et al.  Hypertension in HIV-Infected Adults: Novel Pathophysiologic Mechanisms , 2018, Hypertension.

[18]  P. Collins,et al.  Noncommunicable diseases among HIV-infected persons in low-income and middle-income countries: a systematic review and meta-analysis , 2018, AIDS.

[19]  R. Brook,et al.  2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. , 2018, Journal of the American Society of Hypertension : JASH.

[20]  Z. Chirwa,et al.  High rates of hypertension, diabetes, elevated low-density lipoprotein cholesterol, and cardiovascular disease risk factors in HIV-infected patients in Malawi , 2017, AIDS.

[21]  C. Staton,et al.  Epidemiology of hypertension in Northern Tanzania: a community-based mixed-methods study , 2017, BMJ Open.

[22]  Xinguang Chen,et al.  Global prevalence of hypertension among people living with HIV: a systematic review and meta-analysis. , 2017, Journal of the American Society of Hypertension : JASH.

[23]  C. Ngin,et al.  Non-communicable diseases and related risk behaviors among men and women living with HIV in Cambodia: findings from a cross-sectional study , 2017, International Journal for Equity in Health.

[24]  S. Norris,et al.  Incidence and prevalence of type 2 diabetes mellitus with HIV infection in Africa: a systematic review and meta-analysis , 2017, BMJ Open.

[25]  M. Burton,et al.  Prevalence, Risk Factors, and Complications of Diabetes in the Kilimanjaro Region: A Population-Based Study from Tanzania , 2016, PloS one.

[26]  S. Abebe,et al.  Diabetes mellitus among HIV-infected individuals in follow-up care at University of Gondar Hospital, Northwest Ethiopia , 2016, BMJ Open.

[27]  O. Uthman,et al.  Evidence of increased blood pressure and hypertension risk among people living with HIV on antiretroviral therapy: a systematic review with meta-analysis , 2016, Journal of Human Hypertension.

[28]  M. Petersen,et al.  Population-Based Assessment of Hypertension Epidemiology and Risk Factors among HIV-Positive and General Populations in Rural Uganda , 2016, PloS one.

[29]  D. Fitzgerald,et al.  Glucose Metabolism Disorders, HIV and Antiretroviral Therapy among Tanzanian Adults , 2015, PloS one.

[30]  A. Kengne,et al.  Burden, Determinants, and Pharmacological Management of Hypertension in HIV-Positive Patients and Populations: A Systematic Narrative Review. , 2015, AIDS reviews.

[31]  M. Suthanthiran,et al.  Hypertension, kidney disease, HIV and antiretroviral therapy among Tanzanian adults: a cross-sectional study , 2014, BMC Medicine.

[32]  A. Lazzarin,et al.  Risk of type 2 diabetes among HIV-infected and healthy subjects in Italy , 2012, European Journal of Epidemiology.

[33]  A. Roverato,et al.  Premature age-related comorbidities among HIV-infected persons compared with the general population. , 2011, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[34]  S. Bozzette HIV and Cardiovascular Disease. , 2011, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[35]  Patrick E. Georgoff,et al.  A1C Underestimates Glycemia in HIV Infection , 2009, Diabetes Care.

[36]  M. Egger,et al.  Factors associated with the incidence of type 2 diabetes mellitus in HIV-infected participants in the Swiss HIV Cohort Study. , 2007, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[37]  Jun Yu Li,et al.  Weight gain among treatment-naïve persons with HIV starting integrase inhibitors compared to non-nucleoside reverse transcriptase inhibitors or protease inhibitors in a large in , 2020 .

[38]  H. Kovari,et al.  Characteristics , Prevention , and Management of Cardiovascular Disease in People Living With HIV : A Scientific Statement From the American Heart Association , 2019 .

[39]  D. J. van der Valk,et al.  How accurately can sitting and the intensity of walking and cycling be classified using an accelerometer on the waist for the purpose of the “Global recommendations on physical activity for health”? , 2015 .

[40]  M. de Luise,et al.  Diabetes mellitus. , 1993, The Medical journal of Australia.