Ecological Study of HIV Infection and Hypertension in Sub-Saharan Africa: Is There a Double Burden of Disease?

Abstract

An ecological correlation study of the prevalence of hypertension with human immunodeficiency virus (HIV) prevalence in sub-Saharan Africa was conducted to determine the extent to which these conditions coincide at country level.MethodsData on prevalence of hypertension were derived from a systematic search of literature published between 1975 and 2014 with corresponding national estimates on HIV prevalence and antiretroviral therapy (ART) coverage from the Demographic and Health Surveys and the joint United Nations Programme on HIV/AIDS databases. National estimates on gross national income (GNI) and under-five mortality were obtained from the World Bank database. Linear regression analyses using robust standard errors (allowing for clustering at country level) were carried out for associations of age-standardised hypertension prevalence ratios (standardized to rural Uganda’s hypertension prevalence data) with HIV prevalence, adjusted for national indicators, year of study and sex of the study population.ResultsIn total, 140 estimates of prevalence of hypertension representing 25 nations were sex-and area-matched with corresponding HIV prevalence. A two-fold increase in HIV prevalence was associated with a 9.29% increase in age, sex and study year-adjusted prevalence ratio for hypertension (95% CI 2.0 to 16.5, p = 0.01), which increased to 16.3% (95% CI 9.3 to 21.1) after adjusting for under-five mortality, GNI per capita and ART coverage.ConclusionsCountries with a pronounced burden of HIV may also have an increased burden of non-communicable diseases such as hypertension with potential economic and health systems implications.

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

“…Hypertension is the most prevalent risk factor for CVD globally [57,58] and can be detected by standardized methods using an automated sphygmomanometer. Additionally, body mass can be easily assessed using anthropometry.…”

“…With the advance of urbanization and globalization in LMICs, an epidemiological transition is occurring; our findings clearly show high prevalence of four NCDs among PLHIV. Ecologically, increases in NCD burden have been noted with increasing HIV prevalence [58]. The resulting double-burden of disease has significant potential for adversely affecting population health and current health systems [58].…”

“…Ecologically, increases in NCD burden have been noted with increasing HIV prevalence [58]. The resulting double-burden of disease has significant potential for adversely affecting population health and current health systems [58].…”

Temporal trends in food group availability and cancer incidence in Africa: an ecological analysis

“…Another potential limitation is the lack of data on confounding factors such as physical activity, sedentary behaviour and other lifestyle and environmental factors that may also have changed over the years evaluated in the current analysis. Despite the fact that most cancer incidence is higher in HIV patients (50) , we did not consider HIV infection as a confounder in our analysis because it has been shown previously that African countries with higher HIV infection rates likely have an increased burden of non-communicable diseases, in a situation of coexistence (51) .…”

Control of hypertension in patients with and without HIV

“…Countries with a pronounced HIV burden may also have a higher prevalence of hypertension in this population with potential implications in the economic and health systems [14].…”