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. 2016 Aug 23;11(8):e0158264.
doi: 10.1371/journal.pone.0158264. eCollection 2016.

The Effect of HIV and the Modifying Effect of Anti-Retroviral Therapy (ART) on Body Mass Index (BMI) and Blood Pressure Levels in Rural South Africa

Andrea B Feigl  1   2 , David E Bloom  3 , Goodarz Danaei  3 , Deenan Pillay  2   4 , Joshua A Salomon  3 , Frank Tanser  2   4 , Till W Bärnighausen  3   2   5   6
Affiliations

The Effect of HIV and the Modifying Effect of Anti-Retroviral Therapy (ART) on Body Mass Index (BMI) and Blood Pressure Levels in Rural South Africa

Andrea B Feigl et al. PLoS One. .

Abstract

Background: High BMI and blood pressure are leading chronic disease risk factors in South Africa. Longterm effects of HIV and ART on adiposity and blood pressure are poorly understood, and direct comparisons of risk factor trajectories in HIV- versus HIV+ populations are rare.

Methods: In 2003 and 2010, height, weight, and blood pressure were recorded in a study population (n = 505) in KwaZulu-Natal, South Africa (30% adult HIV prevalence). We modeled change in BMI and BP longitudinally in HIV- individuals (n = 315), seroconverters (n = 32), HIV+ patients not on ART (HIV+ART-; n = 52), HIV+ patients on ART for 0-<2 years as of 2010 (HIV+ART0-<2 yrs; n = 18), patients on ART for 2-5 years (HIV+ART2-5yrs; n = 44), and a subgroup with unknown HIV status (n = 44). Difference-in-differences were assessed in reference to the HIV- population.

Results: Between 2003 and 2010, BMI increased significantly in the HIV- group, by 0.874 (95% CI 0.339, 1.41; p = 0.001), to 30.4. BMI drop was significantly greater in HIV+ART0-<2yrs than in HIV+ART2-5yrs (p = 0.005). DID in BMI in HIV+ART0-<2yrs versus the reference was -5.21 (95% CI -7.53, -2.90; p = 0.001), and DID in HIV+ART2-5yrs versus reference was -1.35 (95% CI -2.89, 0.189; p = 0.086). DID in SBP in HIV+ART-vs HIV- DID was -7.55 mmHg (95% CI -13.2 to -1.90; p = 0.009).

Conclusion: Short-term ART (0-<2 years) was associated with larger weight loss than either no ART or long-term ART. Once on ART for 2+ years, individuals 'caught up' on weight gain with the HIV- population. Our results showcase the importance of health system readiness to address the burgeoning double burden of disease in South Africa.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Study Population.
2111 individuals had both BMI and blood pressure measurements in 2003. This population was comprised of females 25-49yrs old and males 25-54yrs old who lived in the ACDIS catchment area, were residents, were visited by a fieldworker, and completed the full demographic survey, in addition to the WHO STEPS survey which included BMI and BP measurements. 505 individuals had survey, BMI, and BP measurements both in 2003 and 2010. These individuals constitute the main, complete-case study population. For the IPW sensitivity analyses, baseline information of all individuals except those who died and were very sick was used to calculate inverse probability weights.
See this image and copyright information in PMC

References

    1. Shisana O, Rehle T, Simbayi L, Zuma K, Jooste S, Zungu N, et al. South African National HIV Prevalence, Incidence and Behaviour Survey, 2012. Cape Town: HSRC Press, 2014. - PubMed
    1. HSRC. 2012 South Africa Household Survey. 2013.
    1. UNAIDS. UNAIDS AIDSInfo 2013 [cited 2013 October 26 2013]. Available from: www.unaids.org/en/regionscountries/countries/southafrica/.
    1. IHME. GLOBAL BURDEN OF DISEASES, INJURIES, AND RISK FACTORS STUDY 2010. Seattle, Washington: IHME, 2013.
    1. Statistics South Africa. Mortality and causes of death in South Africa, 2011: Findings from death notification. Pretoria: Statistics South Africa, 2014.

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