GLOBAL PREVALENCE OF HYPERTENSION AMONG ART-NAÏVE ADULTS LIVING WITH HIV: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Objective: Cardiometabolic diseases have been suggested to be more frequent in people living with HIV (PLWH), resulting from the chronic inflammatory effects of the virus, effects of antiretroviral therapy (ART) and other factors that operate in the general population. Most studies have focused on assessing the prevalence of hypertension in PLWH on ART. Therefore, this study aimed to estimate the global prevalence of hypertension in the ART-naïve PLWH and to compare the prevalence among ART-naïve, ART-treated and HIV-negative subgroups. PROSPERO Registration: CRD42021226001. Design and method: We searched PubMed-MEDLINE, CINAHL, SCOPUS, Academic-Search Premier, Africa-Wide Information and Africa-Journals Online databases to identify relevant studies published before September 2022. We included Cross-sectional, cohort and case-control studies reporting baseline data on the prevalence of hypertension among ART-naïve adults living with HIV, worldwide. Two authors independently screened, selected, extracted data, and conducted methodological quality assessments. Data reported were pooled using random-effects meta-analysis. Results: Eighty studies across five continents comprising 204,876 ART-naive PLWH with mean/median ages ranging from 32 – 50 years were included. Most studies were from Africa; 43 (54%). The pooled prevalence of hypertension was 13.6% (95%CI: 10.5 - 17.0) among 39 studies that used a standard definition of hypertension (The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: JNC 7). The prevalence was 13.8% (95%CI: 10.4 - 17.5) based on a blood pressure cut-off of 140/90 mmHg only. There was no significant difference in hypertension prevalence by region, age, CD4 count, viral load, and publication year. Among the 9 studies that reported the prevalence by ART and HIV status, it was 9.6% (95%CI: 5.3 – 14.8), 17.7% (95%CI: 9.6 – 27.4) and 19.3% (95%CI: 10.1 – 30.5) in the ART-naïve, ART-treated and HIV negative subgroups respectively (p = 0.044). There was substantial heterogeneity (all I2 >90%, and all p<0.0001). There was no evidence of publication bias (all Egger test p >0.1286). Conclusions: The prevalence of hypertension in ART-naïve adults living with HIV worldwide is lower than in ART-treated and HIV-negative adults and does not differ by age, CD4 count, viral load, publication year and region.