Associations between HIV status and hypertension status in a high HIV prevalence population in Manicaland: a cross-sectional study of adults

• Published in: Antiviral therapy 2021-12, Vol.26, p.1
• Main Authors: Davis, K, Moorhouse, L, Maswera, R, Mandizvidza, P, Dadirai, T, Museka, T, Nyamukapa, C, Smit, M, Gregson, S
• Format: Article
• Language: English
• Subjects: Antiretroviral therapy; Census; Cross-sectional studies; HIV; Human immunodeficiency virus; Hypertension; Population studies; Risk factors
• ISSN: 1359-6535; 2040-2058

Objectives/aims: Hypertension is the leading modifiable cause of death and disability worldwide. Globally, there is some evidence that people living with HIV (PLHIV) might be at higher risk of hypertension. However, it has also been suggested that in African countries PLHIV may experience a lower prevalence of hypertension. Detailed information about how the burden of hypertension differs by HIV status remains scarce across the region, constraining understanding of whether HIV is a risk factor for hypertension. To begin to bridge the data gap, this study examined whether HIV status and antiretroviral therapy (ART)-exposure were associated with hypertension in Manicaland, Zimbabwe, and whether access to hypertension treatment differed by HIV status. Methods: Cross-sectional data from the most recent survey round of the Manicaland Study, a general population open cohort HIV sero-survey, were analysed. During the round, a household census was performed, then all women aged 15–24 years and all men aged 15–29 years, as well as a random sample of two-thirds of older adults, were eligible to complete a survey and undergo HIV testing. Hypertension was defined as reporting a previous diagnosis by a doctor or nurse. All data was gathered between July 2018 and December 2019. In the analysis, survey responses were weighted using data from the household census, then Chi-squared tests and logistic regression were used to explore whether HIV status and ART-exposure were associated with hypertension. Differences in reported uptake of, and payment for, hypertension treatment by HIV status were examined using Chi-squared tests. Results: The analysis included 9780 participants. Weighted HIV prevalence was 11.1% (95% confidence interval: 10.4%, 11.7%). In univariate analyses there was no evidence of a difference in weighted hypertension prevalence between PLHIV and HIV-negative people (14.1%, 11.9%, 16.3% versus 13.3%, 12.6%, 14.0%; P=0.503) or between ART-exposed and ART-naive PLHIV (14.8%, 12.0%, 17.7% versus 12.8%, 9.1%, 16.4%; P=0.388). Adjusting for socio-demographic variables did not alter this (odds ratios: HIV status: 0.87, 0.69, 1.09; P=0.234, Figure 1; ART-exposure: 0.83, 0.53, 1.30; P=0.411). The proportion of hypertensive people receiving treatment, and paying out-of-pocket, did not differ by HIV status; 43.4% (40.6%, 46.3%) of people treated paid out-of-pocket. Conclusion(s)/discussion: No association was found between HIV and hypertension or between ART and hype