The burden of hypertension, diabetes mellitus, and cardiovascular risk factors among adult Malawians in HIV care: consequences for integrated services

Abstract

BackgroundHypertension and diabetes prevalence is high in Africans. Data from HIV infected populations are limited, especially from Malawi. Integrating care for chronic non-communicable co-morbidities in well-established HIV services may provide benefit for patients by preventing multiple hospital visits but will increase the burden of care for busy HIV clinics.MethodsCross-sectional study of adults (≥18 years) at an urban and a rural HIV clinic in Zomba district, Malawi, during 2014. Hypertension and diabetes were diagnosed according to stringent criteria. Proteinuria, non-fasting lipids and cardio/cerebro-vascular disease (CVD) risk scores (Framingham and World Health Organization/International Society for Hypertension) were determined. The association of patient characteristics with diagnoses of hypertension and diabetes was studied using multivariable analyses. We explored the additional burden of care for integrated drug treatment of hypertension and diabetes in HIV clinics. We defined that burden as patients with diabetes and/or stage II and III hypertension, but not with stage I hypertension unless they had proteinuria, previous stroke or high Framingham CVD risk.ResultsNine hundred fifty-two patients were enrolled, 71.7% female, median age 43.0 years, 95.9% on antiretroviral therapy (ART), median duration 47.7 months. Rural and urban patients’ characteristics differed substantially. Hypertension prevalence was 23.7% (95%-confidence interval 21.1–26.6; rural 21.0% vs. urban 26.5%; p = 0.047), of whom 59.9% had stage I (mild) hypertension. Diabetes prevalence was 4.1% (95%-confidence interval 3.0–5.6) without significant difference between rural and urban settings. Prevalence of proteinuria, elevated total/high-density lipoprotein-cholesterol ratio and high CVD risk score was low. Hypertension diagnosis was associated with increasing age, higher body mass index, presence of proteinuria, being on regimen zidovudine/lamivudine/nevirapine and inversely with World Health Organization clinical stage at ART initiation. Diabetes diagnosis was associated with higher age and being on non-standard first-line or second-line ART regimens.ConclusionAmong patients in HIV care 26.6% had hypertension and/or diabetes. Close to two-thirds of hypertension diagnoses was stage I and of those few had an indication for antihypertensive pharmacotherapy. According to our criteria, 13.0% of HIV patients in care required drug treatment for hypertension and/or diabetes.

Diabetes mellitus and its associated risk factors in patients with human immunodeficiency virus on anti-retroviral therapy at referral hospitals of Northwest Ethiopia

“…However, the prevalence in this study is slightly higher than those reported at Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia (6.9%) [39] and University of Gondar Hospital, Northwest Ethiopia (5.1%) [40]. In addition, our report was higher than the reports of those studies carried out in other countries, including Uganda (4%) [41], Malawi (4.1% and 6.6%) [42,43] Zambia (5.0%) [44], but it is lower than the report of Senegal (14.5%) [45] and Tanzania (18.0%) [46]. The observed difference could be pertaining to variations in the lifestyle and HAART regimens or because of differences in the age distribution of the study participants.…”

Prevalence of hypertension and cardiovascular risk factors among long‐term AIDS survivors: A report from the field

“…in Malawi (median ART duration = 11.6 years) and 22.6% in Uganda (median ART duration = 9.4 years). 32,35 Our findings suggest the higher prevalence of HTN among our cohort may be related to our cohort's longer duration on ART (median duration 12.1 years) and…”

“…27 The prevalence of HTN among HIV-infected adults on ART in other resource-limited settings ranges from 17% to 46%, which likely reflects differences in baseline characteristics, duration of infection and treatment. 1,[28][29][30][31][32][33][34][35][36] Two cohorts have similar ART duration as our study population but much lower prevalence of HTN: 19.3%…”

Conceptualising metabolic disorder in Southern Africa: Biology, history and global health

“…HIV/AIDS remains an infectious disease, even though the wider use of anti-retrovirals means that it can also be accurately described as a chronic disease. Furthermore, the relationship between this infectious but chronic condition and non-communicable diseases such as Type 2 diabetes and cardiovascular disease is very likely to be a feature of Malawi's changing epidemiological profile alongside urbanisation, ageing, changing diets and activity levels (Divala et al 2016;Narayan et al 2014;Levitt et al 2011;Kumwenda et al 2005;Bedell 2014). The role of infection is not confined to that played of HIV/AIDS.…”