Abstract
ObjectiveClinic-based studies have shown that patients with human immunodeficiency virus (HIV) gain weight after initiation of antiretroviral therapy (ART). This study aimed to determine whether the scale-up of ART was associated with a population-level increase in body mass index (BMI) and blood pressure (BP) in a community with high HIV and obesity prevalence.MethodsA household survey was conducted in rural KwaZulu-Natal before ART scale-up (in 2004) and when ART coverage had reached 25% (in 2010). Anthropometric data was linked with HIV surveillance data.ResultsMean BMI decreased in women from 29.9 to 29.1 kg/m2 (P = 0.002) and in men from 24.2 to 23.0 kg/m2 (P < 0.001). Similarly, overweight and obesity prevalence declined significantly in both sexes. Mean systolic BP decreased from 123.0 to 118.2 mm Hg (P < 0.001) among women and 128.4 to 123.2 mm Hg (P < 0.001) among men.ConclusionsLarge-scale ART provision is likely to have caused a decline in BMI at the population level, because ART has improved the survival of those with substantial HIV-related weight loss. The ART scale-up may have created an unexpected opportunity to sustain population-level weight loss in communities with high HIV and obesity prevalence though targeted lifestyle and nutrition interventions.
Highlights
Noncommunicable diseases (NCDs) are rapidly replacing infectious diseases as the leading causes of the disease burden in sub-Saharan Africa (SSA) [1,2]
There have been fears that the antiretroviral therapy (ART) scale-up contributes to the rise in cardiovascular disease (CVD) in SSA by increasing the prevalence of overweight and obesity [6]
We found that mean body mass index (BMI), systolic BP (sBP), and the proportion of the population with overweight and obesity decreased in the first years of the public-sector ART scale-up in a rural community in KwaZulu-Natal with high overall levels of both adiposity and human immunodeficiency virus (HIV)
Summary
Noncommunicable diseases (NCDs) are rapidly replacing infectious diseases as the leading causes of the disease burden in sub-Saharan Africa (SSA) [1,2]. There has been an increasing policy and research interest in the relationship between the HIV epidemic in SSA and the rise in NCDs, in particular cardiovascular disease (CVD) [4]. This relationship is complex as the HIV infection itself, the treatment for HIV, and the timing of treatment during the disease course are all likely to affect the risk of CVD. The effect of ART on CVD risk is likely to vary substantially between different antiretroviral drugs [5,8,9] and with the timing of ART initiation (as there is some evidence that earlier initiation of ART may decrease CVD risk [10])
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