Hypertension and associated factors in HIV-infected patients receiving antiretroviral treatment in Burundi: a cross-sectional study

Hypertension among people living with human immunodeficiency virus in sub-Saharan Africa: a systematic review and meta-analysis

We performed a systematic review and meta-analysis of hypertension in people living with human immunodeficiency virus (HIV) in sub-Saharan Africa (SSA). We searched the PubMed, Google Scholar, African Index Medicus, and Embase databases to identify studies published from January 1, 2010, to December 31, 2021. We used a random-effects model to estimate the pooled prevalence of hypertension and mean SBP/DBP level on a sex-specific basis. We included 48 studies reporting data on a pooled sample of 193,843 people living with HIV (PLW-HIV) in SSA. The pooled mean SBP/DBP level was 120 (95% CI 113-128)/77 (95%CI 72-82) mmHg, while the overall pooled prevalence of hypertension was 21.9% (95% CI 19.9-23.9%). Further meta-regression analyses suggested that the prevalence of hypertension was 1.33 times greater in males, 1.23 times greater in individuals receiving antiretroviral therapy (ART) and 1.45 times greater in those individuals with a CD4-count ≥ 200. This meta-analysis of the contemporary pattern of BP levels among PLW-HIV in SSA, suggests that around one in five of such individuals also have hypertension. Given the further context of greater access to ART and subsequently greater longevity, study findings support calls to integrate cardiovascular management into routine HIV care.

Evolving mechanisms and presentations of cardiovascular disease in people with HIV: implications for management

People with HIV (PWH) are at elevated risk for cardiovascular diseases (CVDs), including myocardial infarction, heart failure, and sudden cardiac death, among other CVD manifestations. Chronic immune dysregulation resulting in persistent inflammation is common among PWH, particularly those with sustained viremia and impaired CD4+ T cell recovery. This inflammatory milieu is a major contributor to CVDs among PWH, in concert with common comorbidities (such as dyslipidemia and smoking) and, to a lesser extent, off-target effects of antiretroviral therapy. In this review, we discuss the clinical and mechanistic evidence surrounding heightened CVD risks among PWH, implications for specific CVD manifestations, and practical guidance for management in the setting of evolving data.

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

Background

Dolutegravir (DTG), a new antiretroviral drug, is being integrated into antiretroviral regimens for people with human immunodeficiency virus (PWH) in Ghana. There is little evidence of the effect of DTG on blood pressure (BP) levels in sub-Saharan Africa, especially West Africa. Our aim was to assess the incidence and predictors of hypertension (HTN) among PWH initiated on a DTG-based antiretroviral regimen in Ghana.

Methods

An observational multicenter longitudinal study was conducted among PWH in Ghana from 2020 to 2022. BPs of nonhypertensive patients with BP ≤120/80 mm Hg at baseline were measured at 3, 6, 12, and 18 months post-DTG initiation. The primary outcome of the study was incidence of HTN, defined as BP ≥140/90 mm Hg. Kaplan-Meier estimator was used to estimate risk of developing HTN. Cox proportional hazards model with robust standard errors was used to estimate hazard ratios (HRs).

Results

HTN prevalence among PWH screened was 37.3% (1366/3664). The incidence of de novo HTN among nonhypertensive PWH at 72 weeks was 598.4 per 1000 person-years (PY) (95% confidence interval [CI], 559.2-640.3) with incidence proportion of 59.90 (95% CI, 57.30-62.44). A quarter of those with de novo HTN developed it by month 6. Obesity (adjusted HR [aHR], 1.27 [95% CI, 1.05-1.54]), abnormal serum urea (aHR, 1.53 [95% CI, 1.27-1.85]), and low high-density lipoprotein (aHR, 1.45 [95% CI, 1.22-1.72]) were risk factors for HTN.

Conclusions

Incidence of HTN was high among PWH on DTG. There is a need to monitor BP for HTN in adult PWH as well as traditional risk factors to reduce the burden of HTN and its complications.

Hypertension among persons living with HIV/AIDS and its association with HIV-related health factors

BACKGROUND

Human Immunodeficiency Virus (HIV) infection remains a public health concern in many countries. The increased life expectancy in the post-Antiretroviral Therapy (ART) era has led to an increased risk of cardiovascular disease and death among Persons Living with HIV (PLHIV). Hypertension remains a significant risk factor for cardiovascular disease among PLHIV. Some studies have suggested associations between hypertension among PLHIV and HIV-related health factors.

OBJECTIVE

To determine the prevalence of hypertension among PLHIV on antiretroviral medications and examine its association with HIV-related health factors.

METHODS

A cross-sectional study was conducted among attendants at an adult HIV clinic. 362 study participants were selected by systematic sampling. Data on hypertension diagnosis, HIV-related health factors, sociodemographic and other traditional cardiovascular risk factors were collected using a standardized questionnaire and patient chart review. Multivariate logistic regression model was used to determine the association between hypertension and HIV-related factors, adjusting for other risk factors for hypertension.

RESULTS

The mean age of participants was 47.9 years and majority of participants were female (77.1%). 42% of study participants had been on antiretroviral medications for > 10 years. The prevalence of hypertension was 17.4%. Age > 50 years was associated with higher odds of hypertension (aOR: 3.75, 95%CI 1.68, 8.55, p-value: 0.002). BMI in overweight and obese categories, and a history of comorbid medical conditions (diabetes, hyperlipidemia) were also associated with higher odds of hypertension (aOR: 3. 76, 95%CI 1.44, 9.81, p-value: 0.007), (aOR: 3.17, 95%CI 1.21, 8.32, p-value: 0.019) and (aOR: 14.25, 95%CI 7.41, 27.41, p-value: < 0.001) respectively. No HIV-related health factors were associated with hypertension.

CONCLUSION

Hypertension was a common condition among PLHIV on antiretroviral medications. No HIV-related health factors were associated with hypertension. Traditional risk factors associated with hypertension were increased age > 50 years, increased BMI, and a history of comorbid medical conditions.

Prevalence and Factors Associated with Hypertension Among HIV Positive Patients on Antiretroviral Therapy: A Hospital-Based Cross-Sectional Study in Rwanda

Introduction

The human immunodeficiency virus (HIV) and the use of antiretroviral therapy (ART) are influential elements contributing to hypertension, which is a public health concern particularly in sub-Saharan Africa where its underdiagnosis and limited investigation persist. Moreover, hypertension prevails at higher rates among individuals living with HIV (PLWH) in comparison to the general population. Therefore, our study determined the prevalence of hypertension and its associated factors among PLWH who are undergoing ART treatment at Byumba District Hospital.

Methods

A cross-sectional study design was conducted among 406 PLWH over the age of 14 years who were undergoing ART within the HIV department. We performed statistical analyses using STATA version 13. Significant independent variables identified in the bivariate analysis were further exported in a multivariable logistic regression model to ascertain their association with hypertension. This model elucidated factors associated with hypertension, presenting outcomes through odds ratios and their respective 95% confidence intervals, with statistical significance set at p < 0.05.

Results

The prevalence of hypertension was 24.7%, which means that roughly 1 in 4 PLWH were hypertensive. Notably, individuals aged 41 years and above demonstrated a significant association with heightened hypertension [AOR = 4.49; 95% CI = 2.45-8.21, p < 0.001] in contrast to those aged between 14 and 40 years. Additionally, smokers [AOR = 12.12; 95% CI = 4.48-32.74, p < 0.001] and individuals with a family history of hypertension [AOR = 4.28; 95% CI = 1.01-18.13, p = 0.049] demonstrated a higher likelihood of hypertension than their counterparts. Moreover, alcohol consumers [AOR = 5.5; 95% CI = 2.75-10.9, p < 0.001] had an increased likelihoods of hypertension compared to non-drinkers. Lastly, diabetics were almost 6 times more likely to be hypotensive [AOR = 4.50; 95% CI = 2.55-7.95, p = 0.018] when compared to those without diabetes.

Conclusion

Our findings strongly underscore the urgency for the implementation of targeted programs aimed at enhancing awareness and comprehension of the factors and potential complications tied to hypertension among PLWH. Such programs could be integrated into routine HIV care services to provide patients with the information and skills required to manage their hypertension effectively.

The burden of non-communicable diseases among people living with HIV in Sub-Saharan Africa: a systematic review and meta-analysis

Background

Non-communicable diseases (NCDs) are increasing among people living with HIV (PLHIV), especially in Sub-Saharan Africa (SSA). We determined the prevalence of NCDs and NCD risk factors among PLHIV in SSA to inform health policy makers.

Methods

We conducted a systematic review and meta-analysis on the prevalence of NCDs and risk factors among PLHIV in SSA. We comprehensively searched PubMed/MEDLINE, Scopus, and EBSCOhost (CINAHL) electronic databases for sources published from 2010 to July 2023. We applied the random effects meta-analysis model to pool the results using STATA. The systematic review protocol was registered on PROSPERO (registration number: CRD42021258769).

Findings

We included 188 studies from 21 countries in this meta-analysis. Our findings indicate pooled prevalence estimates for hypertension (20.1% [95% CI:17.5-22.7]), depression (30.4% [25.3-35.4]), diabetes (5.4% [4.4-6.4]), cervical cancer (1.5% [0.1-2.9]), chronic respiratory diseases (7.1% [4.0-10.3]), overweight/obesity (32.2% [29.7-34.7]), hypercholesterolemia (21.3% [16.6-26.0]), metabolic syndrome (23.9% [19.5-28.7]), alcohol consumption (21.3% [17.9-24.6]), and smoking (6.4% [5.2-7.7]).

Interpretation

People living with HIV have a high prevalence of NCDs and their risk factors including hypertension, depression, overweight/obesity, hypercholesterolemia, metabolic syndrome and alcohol consumption. We recommend strengthening of health systems to allow for improved integration of NCDs and HIV services in public health facilities in SSA. NCD risk factors such as obesity, hypercholesterolemia, and alcohol consumption can be addressed through health promotion campaigns. There is a need for further research on the burden of NCDs among PLHIV in most of SSA.

Funding

This study did not receive any funding.

Prevalence and factors associated with hypertension among peoples living with HIV in East Africa, a systematic review and meta-analysis

BACKGROUND

In recent years, improved access to effective antiretroviral therapy has meant that people living with human immune virus are living longer than before. The burden of non-communicable diseases particularly, hypertension parallels with the increase in age. Although hypertension screening is thought to be an effective indicator of overall health status and paves the way for early interventions in peoples living with human immune virus, the exact prevalence of hypertension in this population remained unknown. We aimed to report the prevalence of hypertension and examine the factors associated with hypertension among people living with human immune virus in East Africa.

METHODS

In this systematic review and meta-analysis, we searched PubMed, Science Direct, Scopus, Cochrane library, and Google Scholar databases for studies published until January 1, 2023. The search period was from January 10/2023, to February 10/ 2023. Random-effect models were used to calculate the pooled prevalence of hypertension. Subgroup analyses were conducted to explore potential heterogeneity. The Funnel plot and Egger's test were used to assess publication bias.

RESULT

A total of 15 studies with 10,916 individuals were included in the present meta-analysis. The pooled prevalence of hypertension among people living with human immune virus was19.75% (95% CI, 16.07%-23.42%)),). The prevalence of hypertension was not differed between studies conducted 2014- 2019 and, studies conducted 2020-2022. The prevalence of hypertension was lowest in Ethiopia (16.13%) and highest in Tanzania (26.76%). Alcohol consumption (Adjusted Odds Ratio (AOR): 3.39, 95% CI: 2.35-4.43), diabetes (AOR: 2.64, 95% CI: 1.89-3.39), longer duration of HIV (AOR: 1.72, 95% CI: 1.15-2.3), male sex (AOR: 1.62, 95% CI: 1.43-1.8), obesity (AOR: 2.89, 95% CI: 1.94-3.84), and older age (AOR: 2.25, 95% CI: 2.0-2.5), were the factors associated with the presence of hypertension in people living with human immune virus.

CONCLUSION

Our study shows that one in five peoples living with human immune virus have hypertension causing symptoms and impairment, therefore requiring treatment. Designing effective health screening and hypertension management intervention programs helps to prevent the occurrence of hypertension and promotes peoples' overall quality of life.

The Effect of Cardiorespiratory Exercise in the Prevention and Treatment of Hypertension among HIV-Infected Individuals on Antiretroviral Therapy in Mthatha, South Africa

The prevalence of hypertension among people living with HIV (PLHIV) on antiretroviral therapy (ART) is concerning. Physical activity is a proposed approach for managing and avoiding hypertension in this population. While cardiorespiratory exercises (CET) have been efficacious in the general population, its effectiveness in PLHIV on ART, especially in the study setting, in Mthatha is unknown. Consequently, the purpose of this study was to see if CET improves cardiorespiratory fitness in HAART-treated PLHIV with blood flow restriction (BFR) in Mthatha, South Africa. A quasi-experimental study with 98 participants (49 of whom were cases) was carried out. Cases were participants assigned to the CET intervention group that comprised of concurrent training as it included both aerobic and resistance exercise, matched on age and gender. The relationship between CET and hypertension was assessed using logistic regression after adjusting for possible confounding variables. At baseline, there was no significant difference between the physical characteristics of the two groups, and after the intervention, there was a significant difference. Obesity and central adiposity were identified as strong risk factors for hypertension. The findings also indicated that a reduction in waist circumference and body mass index had a significant positive association with hypertension treatment amongst the intervention group (p < 0.05). According to the results of the study, CET has the potential to be an efficient and economical non-pharmacological intervention for the management and control of hypertension in PLHIV. However, further study is required to establish how long, how intense, and what kind of exercise is best for this population.

Hypertension and traditional risk factors for cardiovascular diseases among treatment naïve HIV- infected adults initiating antiretroviral therapy in Urban Tanzania

BACKGROUND

Cardiovascular diseases (CVDs) have become an important cause of ill health and death among people living with HIV and/or AIDS (PLHIV) in the antiretroviral therapy (ART) era. There is scarce data on the burden of hypertension (HTN) and risk factors for CVDs among PLHIV in developing countries, including Tanzania during the ART era.

OBJECTIVE(S)

To determine the prevalence of HTN and risk factors for CVDs among ART naïve PLHIV initiating ART.

METHODS

We analysed baseline data of 430 clinical trial participants on the effect of low-dose aspirin on HIV disease progression among HIV-infected individuals initiating ART. HTN was the outcome CVD. Traditional risk factors for CVDs studied were age, alcohol consumption, cigarette smoking, individual and family history of CVDs, diabetes mellitus (DM), obesity/overweight, and dyslipidaemia. A generalized linear model (robust Poisson regression) was used to determine the predictors for HTN.

RESULTS

The median (IQR) age was 37 (28, 45) years. Females were the majority contributing 64.9% of all participants. The prevalence of HTN was 24.8%. The most prevalent risk factors for CVDs were dyslipidaemia (88.3%), alcohol consumption (49.3%), and overweight or obesity (29.1%). Being overweight or obese predicted the occurrence of HTN, aPR 1.60 (95% CI 1.16-2.21) while WHO HIV clinical stage 3 was protective against HTN, aPR 0.42(95% CI 0.18-0.97).

CONCLUSION

The prevalence of HTN and traditional risk factors for CVDs in the treatment naïve PLHIV initiating ART are significant. Identifying these risk factors and managing them at the time of ART initiation may lower future CVDs among PLHIV.

Prevalence of Cardiometabolic Disease Risk Factors in People With HIV Initiating Antiretroviral Therapy at a High-Volume HIV Clinic in Kampala, Uganda

Background

Cardiometabolic diseases are a leading cause of HIV-related morbidity and mortality, yet routine screening is not undertaken in high-burden countries. We aimed to assess the prevalence and risk factors of the metabolic syndrome (MetS) and its components in adult Ugandan people with HIV (PWH) initiating dolutegravir-based antiretroviral therapy (ART).

Methods

We conducted a cross-sectional study using baseline sociodemographic and clinical data of PWH aged ≥18 years enrolled in the Glucose metabolism changes in Ugandan HIV patients on Dolutegravir (GLUMED) study from January to October 2021. MetS was defined as having ≥3 of the following: abdominal obesity, hypertension (HTN), hyperglycemia, elevated triglycerides, and low high-density lipoprotein cholesterol. Multiple logistic regression was used to assess associations between potential risk factors and MetS and its components.

Results

Three hundred nine PWH were analyzed (100% ART-naïve, 59.2% female, median age 31 years, and median CD4 count 318 cells/mm3). The prevalence of MetS was 13.9%. The most common cardiometabolic condition was dyslipidemia (93.6%), followed by abdominal obesity (34.0%), hyperglycemia (18.4%), and HTN (8.1%). In adjusted analysis, MetS was associated with age >40 years (adjusted odds ratio [aOR], 3.33; 95% CI, 1.45-7.67) and CD4 count >200 cells/mm3 (aOR, 3.79; 95% CI, 1.23-11.63). HTN was associated with age >40 years (aOR, 2.96; 95% CI, 1.32-6.64), and dyslipidemia was associated with urban residence (aOR, 4.99; 95% CI, 1.35-18.53).

Conclusions

Cardiometabolic risk factors were common in this young Ugandan cohort of PWH initiating dolutegravir-based ART, underscoring the need for programmatic implementation of surveillance and management of comorbidities in Uganda and similar settings.

Lactobacillus maintains IFNγ homeostasis to promote behavioral stress resilience

The gut microbiome consists of the trillions of bacteria, fungi, and viruses that inhabit the digestive tract. These communities are sensitive to disruption from environmental exposures ranging from diet changes to illness. Disruption of the community of lactic acid producing bacteria, Lactobaccillacea , has been well documented in mood disorders and stress exposure. In fact, oral supplement with many Lactobacillus species can ameliorate these effects, preventing depression- and anxiety-like behavior. Here, for the first time, we utilize a gnotobiotic mouse colonized with the Altered Schaedler Flora to remove the two native species of Lactobaccillacea . Using this novel microbial community, we found that the Lactobacillus species themselves, and not the disrupted microbial communities are protective from environmental stressors. Further, we determine that Lactobaccillacea are maintaining homeostatic IFNγ levels which are mediating these behavioral and circuit level responses. By utilizing the Altered Schaedler Flora, we have gained new insight into how probiotics influence behavior and give novel methods to study potential therapies developed to treat mood disorders.