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Int J Epidemiol. 2013 Dec;42(6):1754-71. doi: 10.1093/ije/dyt198.

Association of HIV and ART with cardiometabolic traits in sub-Saharan Africa: a systematic review and meta-analysis.

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  • 1Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, UK, Genetic Epidemiology Group, Wellcome Trust Sanger Institute, Hinxton, Cambridge, UK, MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda, Division of Diabetic Medicine and Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa; Chronic Diseases Initiative in Africa, Department of Chemical Pathology, National Health Laboratory Service, University of the Witwatersrand Medical School, Johannesburg, South Africa, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi, Department of Physiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, Department of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, Royal Victoria Teaching Hospital, School of Medicine, University of The Gambia, Banjul, The Gambia, Department of Medicine, Obafemi Awolowo University, Ile Ife, Nigeria, Women's Equity in Access to Care &Treatment, Kigali, Rwanda, HIV-1 Immunopathogenesis Laboratory, Wistar Institute, Philadelphia, PA, Tuberculosis Research Unit, Department of Medicine, Case Western Reserve University, Cleveland, OH, Department of Medical and Surgical Sciences, University of Padua, Padua, Italy, Division of Diabetic Medicine and Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa, Infectious Diseases Unit, Department of Medicine, Grey's Hospital, Pietermaritzburg, South Africa, Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark, HART (Hypertension in Africa Research Team), North-West University, Potchefstroom, South Africa, Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark, Africa Unit for Transdisciplinary Health Research (AUTHeR), North-West University, Potchefstroom, South Africa, Department of Medicine, Jos University Teachin



Sub-Saharan Africa (SSA) has the highest burden of HIV in the world and a rising prevalence of cardiometabolic disease; however, the interrelationship between HIV, antiretroviral therapy (ART) and cardiometabolic traits is not well described in SSA populations.


We conducted a systematic review and meta-analysis through MEDLINE and EMBASE (up to January 2012), as well as direct author contact. Eligible studies provided summary or individual-level data on one or more of the following traits in HIV+ and HIV-, or ART+ and ART- subgroups in SSA: body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides (TGs) and fasting blood glucose (FBG) or glycated hemoglobin (HbA1c). Information was synthesized under a random-effects model and the primary outcomes were the standardized mean differences (SMD) of the specified traits between subgroups of participants.


Data were obtained from 49 published and 3 unpublished studies which reported on 29 755 individuals. HIV infection was associated with higher TGs [SMD, 0.26; 95% confidence interval (CI), 0.08 to 0.44] and lower HDL (SMD, -0.59; 95% CI, -0.86 to -0.31), BMI (SMD, -0.32; 95% CI, -0.45 to -0.18), SBP (SMD, -0.40; 95% CI, -0.55 to -0.25) and DBP (SMD, -0.34; 95% CI, -0.51 to -0.17). Among HIV+ individuals, ART use was associated with higher LDL (SMD, 0.43; 95% CI, 0.14 to 0.72) and HDL (SMD, 0.39; 95% CI, 0.11 to 0.66), and lower HbA1c (SMD, -0.34; 95% CI, -0.62 to -0.06). Fully adjusted estimates from analyses of individual participant data were consistent with meta-analysis of summary estimates for most traits.


Broadly consistent with results from populations of European descent, these results suggest differences in cardiometabolic traits between HIV-infected and uninfected individuals in SSA, which might be modified by ART use. In a region with the highest burden of HIV, it will be important to clarify these findings to reliably assess the need for monitoring and managing cardiometabolic risk in HIV-infected populations in SSA.


ART; HIV; cardiometabolic disease; sub-Saharan Africa

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