Hypertension, Diabetes, and cardiovascular diseases comorbidities among peoples living with HIV in sub-Saharan Africa: A systematic review and meta analysis

Abstract

Background: HIV and non-communicable diseases (NCDs) comorbidities, particularly hypertension, diabetes mellitus and cardiovascular diseases, are major public health concerns worldwide, especially in hard burden regions like sub-Saharan Africa. Mortality due to non communicable diseases has been rising and now account for the majority of deaths in people living with HIV. However, the available evidence is primarily at the national or localized study level, highlighting the need for pooled evidence on the range of NCDs to better understand the magnitude of the problem and inform policy measures. Objective: To estimate the pooled prevalence and summarize effect size of factors associated with hypertension, diabetes, and cardiovascular diseases comorbidities among people living with HIV in sub-Saharan Africa. Method: This systematic review and meta-analysis were conducted following the recommendation of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We included cross-sectional, case-control, and cohort studies that reported prevalence estimates for hypertension, diabetes, and cardio-vascular disease and the corresponding associated factors among peoples living with HIV. Key terms and initial search strings, further enhanced by an expert librarian, were used to conduct a comprehensive literature search in major databases, including PubMed, EMBASE, Web of Science, and Scopus. The title/abstract screening, full text review, quality assessment, and data extraction processes were conducted in Covidence systematic review software: https://www.covidence.org. This study used a random model to pool effect estimates due to significant between study heterogeneity. Subgroup, sensitivity, and meta-regression were conducted as needed. All statistical tests were declared significant at P-value<0.05. The protocol of this systematic review and meta-analysis was registered in the International Prospective Register of Systematic Reviews (PROSPERO) with registration number CRD42024508838 (https://www.crd.york.ac.uk/prospero/display_record.php). Result: This meta-analysis included 99 primary studies from 16 countries, with a total of 499,351 participants. The regional distribution of the studies was: Eastern Africa (n=49), Southern Africa (n=30), West Africa (n=12), and Central Africa (n=8). The pooled prevalences were 19% for hypertension (95% CI: 18, 21; I2, 99.2%, P-value=0.0001), 5% for diabetes (95% CI: 4, 7; I2, 98.2%, P-value=0.0001) and 5% for cardiovascular disease (95% CI: 1,13 I2, 99.5%,P-value=0.0001). The pooled effect estimates of factors associated with these outcomes were: age (hypertension: AOR= 4.15; 95% CI: 2.77, 6.21; I2, 97.7%, P-value=0.0001, diabetes mellitus: AOR= 2.37, 95% CI: 1.82,3.08; I2, 92.2%, P-value=0.0001); ART-duration (hypertension: AOR = 1.9, 95% CI: 1. 36, 2.65; I2, 93.6%, P-value=0.0001, diabetes mellitus: AOR= 4.63, 95% CI: 1. 60, 13.43; I2, 95.7% P-value=0.0001). Additionally, BMI (AOR=1.68, 95% CI: 1.49, 1.89; I2, 95.2%, P-value=0.0001), DM comorbidity (AOR=3.3 95% CI: 2.1,5.19) I2, 81.7% P-value=0.0001) and male gender (AOR=, 1.42 95% CI: 1.26, 1.60; I2,80% P value=0.0001) were associated with hypertension. Hypertension co-morbidity among adults living with HIV also increased the risk of developing diabetes mellitus (AOR = 3.74, 95% CI: 2. 42 to 5.78; I2, 1% P-value=0.996). Conclusion and recommendation: This meta-analysis reveals a significant prevalence of NCD comorbidities among adults living with HIV, threatening quality of life and increasing mortality and reversing gains from ART. Those communicated disease was associated with age, body mass index, ART-duration, comorbidity and being male. The findings suggested interventional strategies to life style changes to address the significant factors. We recommend age-appropriate interventions, lifestyle modifications, gender-based risk stratification, and tailored ART regimens to minimize risks. Additionally, integrating routine NCD screening into HIV care is crucial for early detection and management, improving long-term outcomes for individuals living with HIV.