Body mass index and noninfectious comorbidity in HIV‐positive patients commencing antiretroviral therapy in Zimbabwe

Abstract

The aim of the study was to describe the prevalence of elevated body mass index (BMI) in a cohort of treatment-na€ ıve people living with HIV (PLWH) and to investigate the association of BMI with CD4 count and noninfectious comorbidities including hypertension and renal impairment. Methods A retrospective cohort study of 1598 PLWH at the Newlands Clinic in Harare, Zimbabwe was carried out. Data were extracted from the medical records at baseline and 6 months after initiation of treatment. The univariate association between BMI and CD4 count was assessed and multiple regression models were used to predict factors associated with loss of renal function and change in CD4 count at 6 months. Results Overweight and obesity (BMI ≥ 25 kg/m 2) were prevalent in this cohort (34%), as was the presence of hypertension (18%). Higher BMI was associated with a higher CD4 count at baseline and 6 months (B = 0.28 and 0.24, respectively; P < 0.001 for both), adjusted for age and sex. The presence of hypertension independently predicted loss of renal function at 6 months (B = À15.31; P < 0.001), adjusted for BMI, CD4 count and sex. High BMI itself was also independently associated with a decline in renal function (B = À0.41; P = 0.003), adjusted for other significant variables. Conclusions We demonstrate a high prevalence of overweight/obesity and hypertension in an urban cohort of PLWH in Zimbabwe. Higher BMI was associated with a higher CD4 count, both before and 6 months after commencing antiretroviral therapy; it was also associated with loss of renal function in this cohort.

Associations between HIV status and self-reported hypertension in a high HIV prevalence sub-Saharan African population: a cross-sectional study

“…The prevalence of self-reported hypertension in PLHIV in Manicaland was 14.1% (11.9% to 16.3%), which is similar to earlier estimates of 8.9%, 18.3% and 19.8% from elsewhere in the country. [14][15][16] The alignment of this study's findings with previous estimates indicates that the results may be a realistic representation of the prevalence of hypertension. However, this means that there is already an important burden of hypertension in PLHIV in Zimbabwe, which is likely to grow as the population grows older and unhealthy lifestyles become more widespread.…”

“…6 In Zimbabwe, only three studies have examined the burden of hypertension among PLHIV in the community, and all lacked a comparison group of HIVnegative people. [14][15][16] Just one of these studies examined the effect of antiretroviral therapy (ART) on hypertension, reporting that long-term use of ART was associated with increased prevalence of hypertension, a finding that has not been replicated in this setting. 14 Bridging the data gap will be crucial to supporting strategic decision-making about provision of preventative services and hypertension treatment.…”

Association Between Body Mass Index Variation and Early Mortality Among 834 Ethiopian Adults Living with HIV on ART: A Joint Modelling Approach

“…This strong association could result from the recovery in adaptive and innate immunity elements after ART initiation [ 27 ]. Evidence furthermore suggests that a higher BMI is associated with higher CD4 cell counts at baseline and after 6 months [ 28 ]. The association between BMI improvement and early mortality could also reflect a negative association between BMI on OIs since OIs are the leading cause of mortality and morbidity among PLHIV [ 29 ].…”

Comparison of predictors for early and late mortality in adults commencing HIV antiretroviral therapy in Zimbabwe: a retrospective cohort study

“…However, deleterious changes from hypertension have been shown to occur within this timeframe. In previously published data from this same cohort, hypertension predicted renal function loss over a period of only six months [ 20 ]. These findings suggest the clinical importance of identifying those with hypotension, as this may contribute to elevated early mortality risk.…”