Skip to main content

HIV and cardiovascular disease in sub-Saharan Africa: Demographic and Health Survey data for 4 countries

Abstract

Background

Investigate the relationship between two common cardiovascular diseases and HIV in adults living in sub-Saharan Africa using population data provided through the Demographic and Health Survey.

Methods

Data for four sub-Saharan countries were used. All adults asked questions regarding diagnosis of HIV, diabetes, and hypertension were included in the sample totaling 5356 in Lesotho, 3294 in Namibia, 9917 in Senegal, and 1051 in South Africa. Logistic models were run for each country separately, with self-reported diabetes as the first outcome and self-reported hypertension as the second outcome and HIV status as the primary independent variable. Models were adjusted for age, gender, rural/urban residence and BMI. Complex survey design allowed weighting to the population.

Results

Prevalence of self-reported diabetes ranged from 3.8% in Namibia to 0.5% in Senegal. Prevalence of self-reported hypertension ranged from 22.9% in Namibia to 0.6% in Senegal. In unadjusted models, individuals with HIV in Lesotho were 2 times more likely to have self-reported diabetes (OR = 2.01, 95% CI 1.08–3.73), however the relationship lost significance after adjustment. Individuals with HIV were less likely to have self-reported diabetes after adjustment in Namibia (OR = 0.29, 95% CI 0.12–0.72) and less likely to have self-reported hypertension after adjustment in Lesotho (OR = 0.63, 95% CI 0.47–0.83). Relationships were not significant for Senegal or South Africa.

Discussion

HIV did not serve as a risk factor for self-reported cardiovascular disease in sub-Saharan Africa during the years included in this study. However, given the growing prevalence of diabetes and hypertension in the region, and the high prevalence of undiagnosed cardiovascular disease, it will be important to continue to track and monitor cardiovascular disease at the population level and in individuals with and without HIV.

Conclusions

The odds of self-reported diabetes in individuals with HIV was high in Lesotho and low in Namibia, while the odds of self-reported hypertension in individuals with HIV was low across all 4 countries included in this study. Programs are needed to target individuals that need to manage multiple diseases at once and should consider increasing access to cardiovascular disease management programs for older adults, individuals with high BMI, women, and those living in urban settings.

Peer Review reports

Introduction

Globally, 38 million people were living with human immunodeficiency virus (HIV) at the end of 2019 [1]. The concentration of individuals living with HIV is most noticeable in low- and middle-income countries. For example, more than two-thirds of those living with HIV are in sub-Saharan Africa [2]. The number of individuals who have access to antiretroviral therapy (ART) has increased rapidly, resulting in reductions in AIDS-related deaths by 60% since 2004 [1]. At this time, most countries in sub-Saharan Africa have adopted “treat all” national policies for people living with HIV to ensure timely ART therapy [3]. Largely due to this expansion in treatment, the projected number of individuals living with HIV who are 50 years or older is expected to triple by 2040 in sub-Saharan Africa [4]. As individuals with HIV live longer, comorbidities become increasingly challenging for healthcare systems in low-income countries, especially Africa, to address effectively [5]. As a result, a shift in focus from communicable to non-communicable disease management for those living with HIV has occurred over the past several years [6].

In total, disability adjusted life years (DALYs) attributable to non-communicable diseases increased by 67% between 1990 and 2017 [7]. According to the Global Burden of Diseases, Injuries, and Risk Factors Study, cardiovascular diseases were the second leading non-communicable disease with changes in all-age total DALYs of 51.1 and 126.4% for hypertension and diabetes respectively [6, 7]. Longer life associated with more effective treatment, use of certain antiretroviral medications, and changes in living environments due to economic growth have all been noted as possible reasons for the growing burden of non-communicable diseases in individuals with HIV [8,9,10,11,12,13,14,15,16,17,18,19,20,21]. Urbanization, in particular, has been noted as an important change in sub-Saharan Africa [22]. Urbanization is characterized by a decrease in physical activity and an increase in high caloric food intake, thus being associated with increased risk for non-communicable diseases [22, 23]. This rate is high within sub-Saharan Africa at an annual rate of change of 3%, compared to 0.96% for the United States [22].

Uncertainties surrounding estimates of disease and disease burden across sub-Saharan Africa necessitates an adjustment in research, data collection, health systems structure [4, 7, 8, 24, 25]. Hypertension is estimated to affect 1.13 billion people, two-thirds of which live in low- and middle-income countries [26]. It is also currently the most prevalent non-communicable disease found for patients living with HIV, especially for those 40 years or older [11, 13, 17, 20, 27,28,29,30,31,32,33,34,35,36,37]. A systematic review of published articles between 2000 and 2017 found hypertension prevalence among those living with HIV to range between 6 and 22% across SSA [15]. Country-specific studies published separately provided prevalence data for those living with HIV and who also had hypertension ranging between 10.2 to 29.9% [10,11,12,13, 17, 19, 20, 27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43]. Undiagnosed cases were even higher, ranging from 11.2% in Zimbabwe [11], 13.3% in rural Kenya [28], 60.3% in Malawi [32], and 75% in Ethiopia [12]. Diabetes has also been noted as having a high prevalence in those with HIV, estimated at between 16 and 25% of those living in sub-Saharan Africa with HIV [15]. The prevalence of diabetes was documented in 12 countries, ranging from 2.0 to 13.2% with most common risk factors including age, BMI, and male sex [10, 16, 17, 20, 29, 30, 32, 35, 40, 44,45,46,47]. However, concern remains regarding high levels of undiagnosed diabetes, particularly in low- and middle-income countries [24].

Much of the current literature in this area focuses on single country analysis in a select number of countries, small sample sizes, populations primarily 50 years or older, and use of local or regional data, limiting the generalizability of results [15, 48]. We sought to address these limitations by utilizing a large, nationally representative data set available for a number of countries - the Demographic and Health Survey (DHS). Though DHS publishes estimates for HIV, diabetes, and hypertension independently, they do not investigate co-occurrence or report the odds for individual cardiovascular diseases based on HIV status. Therefore, the aim of this paper is to investigate the relationship between two common cardiovascular diseases (diabetes and hypertension) and HIV in adults living in sub-Saharan Africa using population data.

Methods

Data source and sample

Data from the nationally representative household surveys collected by the Demographic and Health Survey (DHS) program were used for this study [49]. Standard DHS surveys are collected from between 5000 and 30,000 households in countries around the world, with key performance monitoring data collected using a population based clustering by urban or rural regions to allow systematic sampling from the national sample frame for each country [49]. Approval to use DHS data was obtained from the DHS program prior to data download. No further ethics approval is required as data are de-identified and publicly available for use after approval.

Four sub-Saharan countries asked about both diagnosis of cardiovascular disease (diabetes and hypertension) and HIV when collecting Demographic and Health Survey Household questionnaires available at the time of analysis were included in the study. All adults asked questions regarding HIV, diabetes, and hypertension status were included in the analysis. Therefore, data was included for 5356 adults in Lesotho from the year 2014, 3294 adults in Namibia from the year 2013, 9917 adults in Senegal from the years 2010–2011, and 1051 adults in South Africa from the year 2016. Sampling weights, cluster, and strata information provided in each country specific file was used to account for complex survey design and allow weighting to the population.

HIV status

HIV status served as the primary independent variable for all analyses. Blood was collected by the DHS program team from men and women between the ages of 15–49 years to determine HIV status as positive or negative [50]. Blood spots are collected using a finger prick and transported to a laboratory for testing using an initial ELISA test. Retest of 5–10% of negative tests was performed with a second ELISA with Western Blot performed on discordant results. Testing was voluntary, however, analysis by the DHS program on non-response indicated that HIV testing showed minimal bias [50].

Cardiovascular disease status

Diabetes and hypertension status served as primary outcomes for analyses. Each was based on self-report by the respondent using the questions ‘Has a doctor or other health professional ever told you that you had diabetes’ and ‘Have you ever been told by a doctor or other health worker that you had hypertension or high blood pressure?’

Covariates

Adjusted models included the covariates of age, gender, rural/urban residence, and body mass index (BMI). Age was treated as a continuous variable. Gender was self-reported as male or female. Location of residence was based on DHS program determination of either urban or rural residence. BMI was based on height and weight as measured by the DHS program during questionnaire completion.

Statistical analysis

Sample characteristics for each country were calculated using descriptive statistics. A series of logistic models were run to investigate the relationship between HIV and self-reported cardiovascular disease status. Models were run for each country separately, with self-reported diabetes as the first outcome and self-reported hypertension as the second outcome. HIV status served as the primary independent variable for all models and was run first in unadjusted analyses, and secondly adjusted for age, gender, rural/urban residence, and BMI. Statistical analyses were adjusted for complex survey design using survey procedures in Stata v.14. Statistical significance was based on p < 0.05.

Results

Table 1 provides information on general demographics of samples from each country and prevalence of HIV, self-reported diabetes, and self-reported hypertension in each country. Prevalence of HIV was 24.9% in Lesotho, 21.0% in South Africa, 14.3% in Namibia, and 0.7% in Senegal. Prevalence of self-reported diabetes was 3.8% in Namibia, 1.7% in South Africa, 1.2% in Lesotho, and 0.5% in Senegal. Prevalence of self-reported hypertension was 22.9% in Namibia, 15.3% in Lesotho, 9.8% in South Africa, and 0.6% in Senegal.

Table 1 Sample Characteristics for each Sub-Saharan African Country in Analysis

Table 2 provides results from unadjusted models and Table 3 provides results from adjusted models. Individuals with HIV in Lesotho were 2 times more likely to have self-reported diabetes (OR = 2.01, 95% CI 1.08, 3.73), however the relationship lost significance after adjustment. Individuals with HIV in Namibia were 71% less likely to have self-reported diabetes after adjustment than those without HIV (OR = 0.29, 95% CI 0.12, 0.72). While individuals with HIV in Namibia were less likely to have self-reported hypertension in unadjusted models (OR = 0.65, 95% CI 0.47, 0.88), after adjustment only the relationship in Lesotho remained significant (OR = 0.63, 95% CI 0.47, 0.83). Relationships were not significant for Senegal or South Africa in unadjusted or adjusted models.

Table 2 Relationship between HIV and Cardiovascular Disease in Sub-Saharan Africa
Table 3 Adjusted Relationship between HIV and Cardiovascular Disease in Sub-Saharan Africa

Discussion

Based on results of this study, there was country-by-country variable relationship between HIV and cardiovascular disease by country. Though individuals with HIV were more likely to have self-reported diabetes in Lesotho, this relationship was explained by age, sex, residence, and BMI. Individuals in Namibia with HIV were less likely to have self-reported diabetes, and individuals in Lesotho were less likely to have self-reported hypertension, even after adjusting for covariates. This study provides novel findings suggesting HIV did not serve as a risk factor for self-reported cardiovascular disease in Sub-Saharan Africa during the years included in this study. However, given the growing prevalence of diabetes and hypertension in the region, and the high prevalence of undiagnosed cardiovascular disease [51], it will be important to continue to track and monitor cardiovascular disease at the population level and in individuals with and without HIV.

This study adds to the existing literature by providing information on the co-occurrence of HIV and two common cardiovascular disease (diabetes and hypertension) and indicates country by country variability across Sub-Saharan Africa. Similar to other studies, risk for self-reported cardiovascular diseases for those living with HIV reflect risk factors for the general population including age, BMI, sex, and residence. Based on these results, there may be specific sub-populations that should have programs targeted to address needs. First, programs may need to be developed to target individuals with HIV in Lesotho and provide information on managing both HIV and diabetes successfully. Though integration of HIV and non-communicable disease care within low-resource countries is relatively new, success has been documented within several novel programs across Sub-Saharan Africa [52,53,54]. Utilizing established care programs for HIV that are culturally and locally relevant has enabled countries to address non-communicable diseases alongside HIV [53,54,55,56], resulting in increased diabetes clinical services, [54], screening and referrals [53], and a decrease in negative health behaviors [52]. Secondly, as older age and higher BMI were associated with both self-reported diabetes and hypertension across all 4 countries, community-based health education program should highlight the importance of screening for cardiovascular disease in these two populations. Third, as women were more likely to self-report hypertension than men, despite other demographic factors and HIV status, this may be a group where targeted interventions on disease management should be focused. An analysis conducted in South Africa found higher risk for women for heart disease, primarily among those with the risk factor of obesity [57]. This suggests it will be important to address both disease and risk factors when developing programs. Finally, urban residence in Namibia and Senegal was associated with both self-reported diabetes and hypertension. Providing programs in these countries on managing disease within an urban setting may be another important target for public health work. The World Health Organization provides suggested measures to address non-communicable diseases in low- and middle-income countries targeting the impacts of urbanization, including taxes on alcohol and smoking, limiting advertisements, and health promotion through community wide screenings and public awareness campaigns [58]. Other recommendations include a public health approach, similar to efforts taken to address HIV, including multiple sectors and decentralizing of health care [56, 59]. These actions could result in a rapid scale up of non-communicable disease care, simplification and standardization of treatment, and provision of health education through community and peer support [56]. Future work focusing on understanding changes over time and the influence of individual wealth and national economic development will offer additional information to guide future programs.

Though our study focused on multiple countries and used data collected to allow extrapolation to the population level, there are limitations worth noting. First, data is cross-sectional as individuals were not followed over time, and causality between HIV and cardiovascular disease cannot be discussed. Second, diabetes and hypertension status were self-reported and based on prior diagnosis. Given the high burden of undiagnosed cardiovascular diseases in sub-Saharan Africa, this may result in under-reporting in the datset and thus low estimates in this analysis. Third, as data was collected between the years of 2010 and 2016, population level changes in prevalence of HIV, diabetes, and hypertension across these countries may have changed. Finally, results may not be generalizable to other countries and analyses should be replicated with data available from multiple cultures and contexts.

Conclusion

In conclusion, the odds of self-reported diabetes in individuals with HIV was high in Lesotho and low in Namibia, while the odds of self-reported hypertension in individuals with HIV was low across all 4 countries included in this study. Programs are needed to target individuals that need to manage multiple diseases at once and should consider increasing access to cardiovascular disease management programs for older adults, individuals with high BMI, women, and those living in urban settings.

Availability of data and materials

The data set supporting the conclusions of this article are available through request from the Demographic and Health Survey. Registration for datasets can be completed at: https://www.dhsprogram.com/data/new-user-registration.cfm.

References

  1. 1.

    UN Joint Programme on HIV/AIDS (UNAIDS). “Global HIV & AIDS statistics – 2020 Fact Sheet. Accessed at: https://www.unaids.org/en/resources/fact-sheet. Accessed 10 June 2021. 

  2. 2.

    Kaiser Family Foundation. The Global HIV/AIDS Epidemic. Accessed at: https://www.kff.org/global-health-policy/fact-sheet/the-global-hivaids-epidemic/. Accessed 10 June 2021. 

  3. 3.

    Nash D, Yotebieng M, Sohn AH. Treating all people living with HIV in sub-Saharan Africa: a new era calling for new approaches. J Virus Erad. 2018;49(Suppl 2):1–4.

    Google Scholar 

  4. 4.

    Hontelez JAC, et al. The Impact of Antiretroviral Treatment on the Age Composition of the HIV Epidemic in Sub-Saharan Africa. AIDS (London, England). 2012;26(Suppl 1):S19–30, PubMed. https://doi.org/10.1097/QAD.0b013e3283558526.

    CAS  Article  Google Scholar 

  5. 5.

    Bollyky TJ, Templin T, Cohen M, Dieleman JL. Lower-income countries that face the Most rapid shift in noncommunicable disease burden are also the least prepared. Health Aff (Millwood). 2017;36(11):1866–75. https://doi.org/10.1377/hlthaff.2017.0708.

    Article  PubMed Central  Google Scholar 

  6. 6.

    Marquez PV, Farrington JL. No More Disease Silos for Sub-Saharan Africa. BMJ. 2012;345:e5812. https://doi.org/10.1136/bmj.e5812.

    Article  PubMed  Google Scholar 

  7. 7.

    Gouda H, et al. Burden of Non-Communicable Diseases in Sub-Saharan Africa, 1990–2017: Results from the Global Burden of Disease Study 2017. Lancet Global health. 2019;7:e1375–87. https://doi.org/10.1016/S2214-109X(19)30374-2.

    Article  PubMed  Google Scholar 

  8. 8.

    Serrao R, et al. Non-Aids-related comorbidities in people living with HIV-1 aged 50 years and older: the aging positive study. Int J Infect Dis. 2019;79:94–100. https://doi.org/10.1016/j.ijid.2018.10.011.

    Article  PubMed  Google Scholar 

  9. 9.

    Narayan KM, et al. HIV and Noncommunicable Disease Comorbidities in the Era of Antiretroviral Therapy: A Vital Agenda for Research in Low- and Middle-Income Country Settings. J Acquir Immune Defic Syndr. 2014;67(Suppl 1):S2–7. https://doi.org/10.1097/qai.0000000000000267.

    Article  PubMed  Google Scholar 

  10. 10.

    Achwoka D, et al. Noncommunicable Disease Burden among HIV Patients in Care: A National Retrospective Longitudinal Analysis of HIV-Treatment Outcomes in Kenya, 2003–2013. BMC Public Health. 2019;19(1):372. https://doi.org/10.1186/s12889-019-6716-2.

    Article  PubMed  PubMed Central  Google Scholar 

  11. 11.

    Chireshe R, et al. Hypertension among human immunodeficiency virus infected patients on treatment at Parirenyatwa Hospital: A descriptive study. Afr J Prim Health Fam Med. 2019;11:1 e1-e8. https://doi.org/10.4102/phcfm.v11i1.1974.

    Article  Google Scholar 

  12. 12.

    Fiseha T, Belete AG. Diabetes mellitus and its associated factors among human immunodeficiency virus-infected patients on anti-retroviral therapy in Northeast Ethiopia. BMC Res Notes. 2019;12(1):372. https://doi.org/10.1186/s13104-019-4402-1.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  13. 13.

    Brennan AT, et al. Prevalence, Incidence, Predictors, Treatment, and Control of Hypertension among HIV-Positive Adults on Antiretroviral Treatment in Public Sector Treatment Programs in South Africa. Plos One. 2018;13(10):e0204020. https://doi.org/10.1371/journal.pone.0204020.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  14. 14.

    Rankgoane-Pono G, et al. Incidence of Diabetes Mellitus-Related Comorbidities among Patients Attending Two Major HIV Clinics in Botswana: A 12-Year Retrospective Cohort Study. BMC Res Notes. 2018;11(1):90. https://doi.org/10.1186/s13104-018-3144-9.

    Article  PubMed  PubMed Central  Google Scholar 

  15. 15.

    Hyle EP, et al. The Association between HIV and Atherosclerotic Cardiovascular Disease in Sub-Saharan Africa: A Systematic Review. BMC Public Health. 2017;17(1):954. https://doi.org/10.1186/s12889-017-4940-1.

    Article  PubMed  PubMed Central  Google Scholar 

  16. 16.

    Noumegni SRN, Nansseu JR, Ama VJM, Bigna JJ, Assah FK, Guewo-Fokeng M, et al. Insulin resistance and associated factors among HIV-infected patients in sub-Saharan Africa: a cross sectional study from Cameroon. Lipids Health Dis. 2017;16(1):148. https://doi.org/10.1186/s12944-017-0543-1.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  17. 17.

    Divala OH, Amberbir A, Ismail Z, Beyene T, Garone D, Pfaff C, et al. The burden of hypertension, diabetes mellitus, and cardiovascular risk factors among adult Malawians in HIV care: consequences for integrated services. BMC Public Health. 2016;16(1):1243. https://doi.org/10.1186/s12889-016-3916-x.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  18. 18.

    Clark SJ, et al. Cardiometabolic Disease Risk and HIV Status in Rural South Africa: Establishing a Baseline. BMC Public Health. 2015;15:135. https://doi.org/10.1186/s12889-015-1467-1.

    Article  PubMed  PubMed Central  Google Scholar 

  19. 19.

    Dimala CA, Atashili J, Mbuagbaw JC, Wilfred A, Monekosso GL. A comparison of the diabetes risk score in HIV/AIDS patients on highly active antiretroviral therapy (Haart) and Haart-naive patients at the Limbe regional hospital, Cameroon. Plos One. 2016;11(5):e0155560. https://doi.org/10.1371/journal.pone.0155560.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  20. 20.

    Kagaruki GB, et al. Magnitude and Risk Factors of Non-Communicable Diseases among People Living with HIV in Tanzania: A Cross Sectional Study from Mbeya and Dar Es Salaam Regions. BMC Public Health. 2014;14:904. https://doi.org/10.1186/1471-2458-14-904.

    Article  PubMed  PubMed Central  Google Scholar 

  21. 21.

    Dillon DG, Gurdasani D, Riha J, Ekoru K, Asiki G, Mayanja BN, et al. Association of HIV and art with Cardiometabolic traits in sub-Saharan Africa: a systematic review and meta-analysis. Int J Epidemiol. 2013;42(6):1754–71. https://doi.org/10.1093/ije/dyt198.

    Article  PubMed  Google Scholar 

  22. 22.

    Mbanya JC, et al. Diabetes in sub-Saharan Africa. Lancet. 2010;375(9733):2254–66. https://doi.org/10.1016/s0140-6736(10)60550-8.

    Article  PubMed  Google Scholar 

  23. 23.

    Werfalli M, Engel ME, Musekiwa A, Kengne AP, Levitt NS. The prevalence of type 2 diabetes among older people in Africa: a systematic review. Lancet Diabetes Endocrinol. 2016;4(1):72–84. https://doi.org/10.1016/s2213-8587(15)00363-0.

    Article  PubMed  Google Scholar 

  24. 24.

    International Diabetes Federation. IDF Diabetes Atlas. 9th ed. Brussels: International Diabetes Federation; 2019.

    Google Scholar 

  25. 25.

    Nyaaba GN, et al. Tracing Africa’s Progress Towards Implementing the Non-Communicable Diseases Global Action Plan 2013–2020: A Synthesis of Who Country Profile Reports. BMC Public Health. 2017;17(1):297. https://doi.org/10.1186/s12889-017-4199-6.

    Article  PubMed  PubMed Central  Google Scholar 

  26. 26.

    World Health Organization. Hypertension. Accessible from: https://www.who.int/news-room/fact-sheets/detail/hypertension. Accessed 10 June 2021.

  27. 27.

    Albrecht S, et al. Age-Related Comorbidities and Mortality in People Living with HIV in Rural Tanzania. AIDS (London). 2019;33(6):1031–41. https://doi.org/10.1097/qad.0000000000002171.

    Article  Google Scholar 

  28. 28.

    Juma K, Nyabera R, Mbugua S, Odinya G, Jowi J, Ngunga M, et al. Cardiovascular risk factors among people living with HIV in rural Kenya: a clinic-based study. Cardiovasc J Afr. 2019;30(1):52–6. https://doi.org/10.5830/cvja-2018-064.

    Article  PubMed  Google Scholar 

  29. 29.

    Dawood H, Hassan-Moosa R, Zuma NY, Naidoo K. Mortality and treatment response amongst HIV -infected patients 50 years and older accessing antiretroviral Services in South Africa. BMC Infect Dis. 2018;18(1):168. https://doi.org/10.1186/s12879-018-3083-z.

    Article  PubMed  PubMed Central  Google Scholar 

  30. 30.

    Ekrikpo UE, Akpan EE, Ekott JU, Bello AK, Okpechi IG, Kengne AP. Prevalence and correlates of traditional risk factors for cardiovascular disease in a Nigerian art-naive HIV population: a cross-sectional study. BMJ Open. 2018;8(7):e019664. https://doi.org/10.1136/bmjopen-2017-019664.

    Article  PubMed  PubMed Central  Google Scholar 

  31. 31.

    Kansiime S, Mwesigire D, Mugerwa H. Prevalence of non-communicable diseases among HIV positive patients on antiretroviral therapy at joint clinical research Centre, Lubowa, Uganda. Plos One. 2019;14(8):e0221022. https://doi.org/10.1371/journal.pone.0221022.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  32. 32.

    Rücker M, Sekai C, et al. High Rates of Hypertension, Diabetes, Elevated Low-Density Lipoprotein Cholesterol, and Cardiovascular Disease Risk Factors in HIV -Infected Patients in Malawi. AIDS (London). 2018;32(2):253–60, PubMed. https://doi.org/10.1097/QAD.0000000000001700.

    CAS  Article  Google Scholar 

  33. 33.

    Rodriguez-Arboli E, et al. Incidence and risk factors for hypertension among HIV patients in rural Tanzania - a prospective cohort study. Plos One. 2017;12(3):e0172089. https://doi.org/10.1371/journal.pone.0172089.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  34. 34.

    Kalyesubula R, Kayongo A, Semitala FC, Muhanguzi A, Katantazi N, Ayers D, et al. Trends and level of control of hypertension among adults attending an ambulatory HIV Clinic in Kampala, Uganda: a retrospective study. BMJ Glob Health. 2016;1(3):e000055. https://doi.org/10.1136/bmjgh-2016-000055.

    Article  PubMed  PubMed Central  Google Scholar 

  35. 35.

    Magodoro IM, et al. A Cross-Sectional, Facility Based Study of Comorbid Non-Communicable Diseases among Adults Living with HIV Infection in Zimbabwe. BMC Res Notes. 2016;9(1):379. https://doi.org/10.1186/s13104-016-2187-z.

    Article  PubMed  PubMed Central  Google Scholar 

  36. 36.

    Okello S, Kanyesigye M, Muyindike WR, Annex BH, Hunt PW, Haneuse S, et al. Incidence and predictors of hypertension in adults with HIV -initiating antiretroviral therapy in South-Western Uganda. J Hypertens. 2015;33(10):2039–45. https://doi.org/10.1097/hjh.0000000000000657.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  37. 37.

    Peck RN, et al. Hypertension, Kidney Disease, HIV and Antiretroviral Therapy among Tanzanian Adults: A Cross-Sectional Study. BMC Med. 2014;12:125. https://doi.org/10.1186/s12916-014-0125-2.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  38. 38.

    George S, McGrath N, Oni T. The association between a detectable HIV viral load and non-communicable diseases comorbidity in HIV positive adults on antiretroviral therapy in Western cape, South Africa. BMC Infect Dis. 2019;19(1):348, PubMed. https://doi.org/10.1186/s12879-019-3956-9.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  39. 39.

    Osetinsky B, et al. Epidemiological and Health Systems Implications of Evolving HIV and Hypertension in South Africa and Kenya. Health Affairs. 2019;38(7):1173–81. https://doi.org/10.1377/hlthaff.2018.05287.

    Article  PubMed  Google Scholar 

  40. 40.

    Ngu RC, Choukem SP, Dimala CA, Ngu JN, Monekosso GL. Prevalence and determinants of selected cardio-metabolic risk factors among people living with HIV /AIDS and receiving Care in the South West Regional Hospitals of Cameroon: a cross-sectional study. BMC Res Notes. 2018;11(1):305. https://doi.org/10.1186/s13104-018-3444-0.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  41. 41.

    Chimbetete C, Mugglin C, Shamu T, Kalesan B, Bertisch B, Egger M, et al. New-onset type 2 diabetes mellitus among patients receiving HIV Care at Newlands Clinic, Harare, Zimbabwe: retrospective cohort analysis. Tropical Med Int Health. 2017;22(7):839–45. https://doi.org/10.1111/tmi.12896.

    Article  Google Scholar 

  42. 42.

    Ogunmola OJ, Oladosu OY, Olamoyegun AM. Association of Hypertension and Obesity with HIV and antiretroviral therapy in a rural tertiary health Center in Nigeria: a cross-sectional cohort study. Vasc Health Risk Manag. 2014;10:129–37. https://doi.org/10.2147/vhrm.S58449.

    Article  PubMed  PubMed Central  Google Scholar 

  43. 43.

    Mateen FJ, et al. Hypertension Prevalence and Framingham Risk Score Stratification in a Large HIV -Positive Cohort in Uganda. J Hypertens. 2013;31(7):1372–8. https://doi.org/10.1097/HJH.0b013e328360de1c.

    CAS  Article  PubMed  Google Scholar 

  44. 44.

    Abebe SM, Getachew A, Fasika S, Bayisa M, Girma Demisse A, Mesfin N. Diabetes mellitus among HIV -infected individuals in follow-up Care at University of Gondar hospital, Northwest Ethiopia. BMJ Open. 2016;6(8):e011175. https://doi.org/10.1136/bmjopen-2016-011175.

    Article  PubMed  PubMed Central  Google Scholar 

  45. 45.

    Isa SE, Oche AO, Kang'ombe AR, Okopi JA, Idoko JA, Cuevas LE, et al. Human immunodeficiency virus and risk of type 2 diabetes in a large adult cohort in Jos, Nigeria. Clin Infect Dis. 2016;63(6):830–5. https://doi.org/10.1093/cid/ciw381.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  46. 46.

    Rhee JY, Bahtila TD, Palmer D, Tih PM, Aberg JA, LeRoith D, et al. Prediabetes and diabetes among HIV -infected adults in Cameroon. Diabetes Metab Res Rev. 2016;32(6):544–9. https://doi.org/10.1002/dmrr.2792.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  47. 47.

    Steiniche D, Jespersen S, Erikstrup C, Krarup H, Handberg A, Østergaard L, et al. Diabetes mellitus and impaired fasting glucose in art-naive patients with HIV -1, HIV −2 and HIV −1/2 dual infection in Guinea-Bissau: a cross-sectional study. Trans R Soc Trop Med Hyg. 2016;110(4):219–27. https://doi.org/10.1093/trstmh/trw017.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  48. 48.

    Prioreschi A, Munthali RJ, Soepnel L, Goldstein JA, Micklesfield LK, Aronoff DM, et al. Incidence and prevalence of type 2 diabetes mellitus with HIV infection in Africa: a systematic review and meta-analysis. BMJ Open. 2017;7(3):e013953. https://doi.org/10.1136/bmjopen-2016-013953.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  49. 49.

    Demographic and Health Survey (DHS). Data description and download available at: https://www.dhsprogram.com/ Accessed 24 June 2020.

  50. 50.

    Demographic and Health Survey (DHS). HIV Prevalence. Available at: https://www.dhsprogram.com/topics/HIV-Corner/hiv-prev/index.cfm Accessed 24 June 2020.

  51. 51.

    Wamai RG, Kengne AP, Levitt N. Non-communicable diseases surveillance: overview of magnitude and determinants in Kenya from STEPwise approach survey of 2015. BMC Publi Health. 2018;18(Suppl 3):1224. https://doi.org/10.1186/s12889-018-6051-z.

    Article  Google Scholar 

  52. 52.

    Juma K, et al. From HIV Prevention to Non-Communicable Disease Health Promotion Efforts in Sub-Saharan Africa: A Narrative Review. AIDS. 2018;32(Suppl 1):S63–s73. https://doi.org/10.1097/qad.0000000000001879.

    Article  PubMed  Google Scholar 

  53. 53.

    Duffy M, Ojikutu B, Andrian S, Sohng E, Minior T, Hirschhorn LR. Non-communicable diseases and HIV care and treatment: models of integrated service delivery. Tropical Med Int Health. 2017;22(8):926–37. https://doi.org/10.1111/tmi.12901.

    Article  Google Scholar 

  54. 54.

    Rabkin M, et al. Strengthening Health Systems for Chronic Care: Leveraging HIV Programs to Support Diabetes Services in Ethiopia and Swaziland. J Trop Med. 2012;2012:137460. https://doi.org/10.1155/2012/137460.

    Article  PubMed  PubMed Central  Google Scholar 

  55. 55.

    Garrib A, Birungi J, Lesikari S, Namakoola I, Njim T, Cuevas L, et al. Integrated Care for Human Immunodeficiency Virus, diabetes and hypertension in Africa. Trans R Soc Trop Med Hyg. 2019;113(12):809–12. https://doi.org/10.1093/trstmh/try098.

    Article  PubMed  Google Scholar 

  56. 56.

    van Olmen J, et al. Management of Chronic Diseases in Sub-Saharan Africa: Cross-Fertilisation between HIV / AIDS and Diabetes Care. J Trop Med. 2012;2012:349312. https://doi.org/10.1155/2012/349312.

    Article  PubMed  PubMed Central  Google Scholar 

  57. 57.

    Stewart S, Carrington MJ, Pretorius S, Ogah OS, Blauwet L, Antras-Ferry J, et al. Elevated risk factors but low burden of heart disease in urban African primary care patients: a fundamental role for primary prevention. Int J Cardiol. 2012;158:2005–10.

    Article  Google Scholar 

  58. 58.

    WHO. From Burden to “Best Buys”: Reducing the Economic Impact of Non-Communicable Diseases in Lowand Middle-Income Countries. Geneva: World Economic Forum; 2011.

    Google Scholar 

  59. 59.

    Juma K, Juma PA, Mohamed SF, Owuor J, Wanyoike A, Mulabi D, et al. First Africa non-communicable disease research conference 2017: sharing evidence and identifying research priorities. J Glob Health. 2019;8(2):020301. https://doi.org/10.7189/jogh.09.010201.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

Not applicable.

Funding

Effort for this study was partially supported by the National Institute of Diabetes and Digestive Kidney Disease (K24DK093699, R01DK118038, R01DK120861, PI: Egede), the National Institute for Minority Health and Health Disparities (R01MD013826, PI: Egede/Walker), and the American Diabetes Association (1–19-JDF-075, PI: Walker).

Author information

Affiliations

Authors

Contributions

LEE acquired data, designed the study, and participated in analysis, interpretation, and drafting of the manuscript. RJW participated in analysis and interpretation, as well as drafting of the manuscript. PM participated in interpretation of results and drafting of the manuscript. JSW participated in interpretation of results and drafting of the manuscript. JAC participated in interpretation of results and drafting of the manuscript. AZD participated in interpretation of results and drafting of the manuscript. All authors revised the manuscript for intellectual content and approved the final version to be published.

Corresponding author

Correspondence to Leonard E. Egede.

Ethics declarations

Ethics approval and consent to participate

The Medical College of Wisconsin Institutional Review Board has provided exemption for publicly available data that has no identifiers, and therefore no local ethics approval was required for this study. Data is part of the Demographic and Health Surveys, which provide further details regarding initial ethical review and procedures followed to ensure informed and voluntary participation located at: https://www.dhsprogram.com/methodology/Protecting-the-Privacy-of-DHS-Survey-Respondents.cfm.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Egede, L.E., Walker, R.J., Monroe, P. et al. HIV and cardiovascular disease in sub-Saharan Africa: Demographic and Health Survey data for 4 countries. BMC Public Health 21, 1122 (2021). https://doi.org/10.1186/s12889-021-11218-5

Download citation

Keywords

  • HIV
  • Diabetes
  • Hypertension
  • Cardiovascular disease
  • Demographic and Health Survey