Association between HIV and Prevalent Hypertension and Diabetes Mellitus in South Africa: analysis of a nationally representative cross-sectional survey

Abstract

Objectives: Cardiovascular diseases (CVD) burden is rising among persons living with HIV (PLWH) in sub-Saharan Africa. It is unclear whether this reflects absolute increase in HIV-related CVD risk or unmasking by improved survival. We, therefore, examined whether HIV is associated with adverse cardiometabolic profiles among South African adults. Methods: We analyzed a nationally-representative dataset (n=6,420), estimating weighted prevalence of hypertension, diabetes, and 10-year predicted risk of incident fatal/non-fatal CVD (if ≥40 years old). Associations between HIV and cardiometabolic indices were assessed using log-binomial regression models adjusted for sociodemographic factors. Results: HIV population prevalence was 18.9% with median age of 36.0 years. Hypertension (44.2 vs. 45.4%), diabetes (18.6 vs. 20.4%) and overweight/obesity (BMI ≥25 kg/m2: 54.9 vs. 52.0%) prevalence did not substantially differ by HIV status, although PLWH had lower 10-year predicted CVD risk (median: 5.1 vs. 13.5%). In adjusted models, HIV- females had a 5 mmHg higher median systolic blood pressure (128 vs. 123 mmHg) than female PLWH. Conclusions: PLWH in South Africa have better cardiometabolic disease profiles than the general population, and social determinants, rather than HIV, may have a greater influence on cardiometabolic risk. Designating PLWH a CVD high-risk group in South Africa is likely unwarranted.