Prevalence of obesity, hypertension and diabetes among people living with HIV in South Africa: a systematic review and meta-analysis

Gizamba, Jacob M.; Davies, Jess; Africa, Chad; Choo-Kang, Candice; Goedecke, Julia H.; Madlala, Hlengiwe; Lambert, Estelle V.; Rae, Dale E.; Myer, Landon; Luke, Amy; Dugas, Lara R.

doi:10.1186/s12879-023-08736-5

Cited by 4 publications

References 77 publications

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Gestational weight gain and adverse birth outcomes in South African women with HIV on antiretroviral therapy and without HIV: a prospective cohort study

Madlala,

Myer,

Jao

et al. 2024

J Int AIDS Soc.

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IntroductionOutside of pregnancy, evidence shows that persons with HIV initiating or switching to dolutegravir (DTG)‐based antiretroviral therapy (ART) experience greater weight gain compared to those on other ART classes. However, there are few data on the impact of DTG‐based ART on gestational weight gain (GWG) in sub‐Saharan Africa where HIV is most common. According to the National Academy of Medicine (NAM), GWG below and above NAM guidelines is associated with adverse birth outcomes. Therefore, the objective of this study was to describe GWG by HIV status and ART regimen, and examine the associations with adverse birth outcomes.MethodsWe enrolled pregnant women with HIV (WHIV) and without HIV (≥18 years) in a peri‐urban primary healthcare facility in Cape Town, South Africa between 2019 and 2022. GWG was study‐measured at 24–28 (baseline) and 33–38 weeks gestation and converted to GWG rate (kg/week) in accordance with NAM guidelines. GWG z‐scores were generated using the INTEGROWTH‐21 and US standards to account for differing lengths of gestation. Birth outcome data were obtained from medical records. Associations of GWG z‐score with adverse birth outcomes were assessed using multivariable linear or log‐binomial regression.ResultsAmong 292 participants (48% WHIV), median age was 29 years (IQR, 25–33), median pre‐pregnancy body mass index (BMI) was 31 kg/m2 (IQR, 26–36) and 20% were primiparous at baseline. The median weekly rate of GWG was 0.30 kg/week (IQR, 0.12–0.50), 35% had GWG below NAM standards (59% WHIV) and 48% had GWG above NAM standards (36% WHIV). WHIV gained weight more slowly (0.25 vs. 0.37 kg/week, p<0.01) than women without HIV. Weekly rate of GWG did not differ by ART regimen (DTG‐based ART 0.25 vs. efavirenz‐based ART 0.27 kg/week, p = 0.80). In multivariable analyses, GWG z‐score was positively associated with continuous birth weight (mean difference = 68.53 95% CI 8.96, 128.10) and categorical high birth weight of >4000 g (RR = 2.18 95% CI 1.18, 4.01).ConclusionsDespite slower GWG among WHIV, nearly half of all women gained weight faster than recommended by the NAM. GWG was positively associated with infant birth weight. Interventions to support healthy GWG in sub‐Saharan Africa are urgently needed.

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Gestational weight gain and adverse birth outcomes in South African women with HIV on antiretroviral therapy and without HIV: a prospective cohort study

Madlala,

Myer,

Jao

et al. 2024

J Int AIDS Soc.

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Morbidity and Mortality Risk Among People With Human Immunodeficiency Virus and Central or Visceral Adiposity: A Targeted Literature Review

Bjornson,

Bedimo,

Szabo

et al. 2024

Clinical Infectious Diseases

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Background Given the known relationship between human immunodeficiency virus (HIV), antiretroviral therapies, and excess visceral adipose tissue (VAT), this review sought to characterize risk of negative health outcomes associated with excess VAT and increased waist circumference (WC) in people with HIV (PWH). Methods Comprehensive targeted literature searches were conducted in Medline/Embase (27 June 2022), identifying peer-reviewed articles and conference abstracts reporting on cohorts of PWH. Screening was guided by PECOS (Population, Exposure, Comparator, Outcomes, Study design) criteria. From the included studies, outcomes of interest including mortality and morbidity risk by VAT area and WC were extracted, overall, and by sex, race/ethnicity, and duration of HIV. Relationships between outcome and exposure variables were summarized. Results Thirty-five studies were included (sample size range: 31–1748 PWH). Twenty-five studies characterized the relationship between increased WC and negative health outcomes—cardiovascular disease (CVD), arteriosclerosis, hypertension, diabetes, hepatic fat and fibrosis, and cognitive impairment—among PWH. Fifteen studies reported on increased VAT and negative health outcomes: all-cause mortality, CVD, atherosclerosis, hepatic fat, and fibrosis. Importantly, there was a 2.1-times higher odds of 5-year all-cause mortality among PWH with the highest amount of VAT in the only study identified reporting on mortality. Among the studies characterizing the relationship between morbidity and VAT, for example, 1 found that, for each 10-cm2 increase in VAT, the risk of prevalent CVD increased by 1.05 (95% CI: 1.0–1.1) times. Conclusions WC may be a useful and cost-effective surrogate for visceral adiposity, which is an important marker of morbidity and mortality among PWH.

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Hypertension Among Cohort of Persons With Human Immunodeficiency Virus Initiated on a Dolutegravir-Based Antiretroviral Regimen in Ghana

Lartey,

Torpey,

Ganu

et al. 2024

Open Forum Infectious Diseases

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Background Dolutegravir, a new antiretroviral drug is being integrated into antiretroviral regimen for PWH in Ghana. There is little evidence of the effect of dolutegravir on blood pressure (BP) levels in sub-Saharan Africa especially West Africa. Aim To assess the incidence and predictors of hypertension (HPTN) among PWH initiated on dolutegravir based antiretroviral regimen in Ghana. Methods An observational multi-center longitudinal study was conducted among PWH in Ghana from 2020 to 2022. Blood pressures of non-hypertensive patients with BP≤120/80mmHg at baseline were measured at 3-, 6-, 12- and 18-months post dolutegravir initiation. The primary outcome of study was incidence of HPTN defined as BP ≥140/90mmHg. Kaplan-Meier estimator was used to estimate risk of developing HPTN. Cox proportional hazard model with robust standard errors was used to estimate hazard ratios. Results HPTN prevalence among PWH screened was 37.3% (1366/3664). The incidence of de novo HPTN among non-hypertensive PWH at 72 weeks was 598.4 per 1000 person years (PY) (95% CI: 559.2-640.3) with incidence proportion of 59.90 (95% CI: 57.30 - 62.44). A quarter of those with de novo HPTN developed it by month six. Being obese (aHR 1.27 (1.05 - 1.54)), having abnormal serum urea (aHR 1.53 (95% CI: 1.27 - 1.85)) and low high-density lipoproteins (aHR 1.45 (1.22 - 1.72)) were risk factors for HPTN. Conclusion Incidence of HPTN was high among PWH on dolutegravir. There is a need to monitor BP for HPTN in adult PWH and also traditional risk factors to reduce the burden of HPTN and its complications.

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Prevalence of obesity, hypertension and diabetes among people living with HIV in South Africa: a systematic review and meta-analysis

Cited by 4 publications

References 77 publications

Gestational weight gain and adverse birth outcomes in South African women with HIV on antiretroviral therapy and without HIV: a prospective cohort study

Gestational weight gain and adverse birth outcomes in South African women with HIV on antiretroviral therapy and without HIV: a prospective cohort study

Morbidity and Mortality Risk Among People With Human Immunodeficiency Virus and Central or Visceral Adiposity: A Targeted Literature Review

Hypertension Among Cohort of Persons With Human Immunodeficiency Virus Initiated on a Dolutegravir-Based Antiretroviral Regimen in Ghana

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