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Meta-Analysis
. 2023 Dec 7;23(1):861.
doi: 10.1186/s12879-023-08736-5.

Prevalence of obesity, hypertension and diabetes among people living with HIV in South Africa: a systematic review and meta-analysis

Jacob M Gizamba  1   2 , Jess Davies  1 , Chad Africa  1 , Candice Choo-Kang  3 , Julia H Goedecke  4 , Hlengiwe Madlala  1 , Estelle V Lambert  5 , Dale E Rae  5 , Landon Myer  1 , Amy Luke  3 , Lara R Dugas  6   7
Affiliations
Meta-Analysis

Prevalence of obesity, hypertension and diabetes among people living with HIV in South Africa: a systematic review and meta-analysis

Jacob M Gizamba et al. BMC Infect Dis. .

Abstract

Background: HIV has become a manageable chronic condition due to the success and scale-up of antiretroviral therapy (ART). Globally, South Africa has the highest number of people living with HIV (PLHIV) and research evidence indicates that countries with the highest burden of PLHIV have a substantial burden of obesity, hypertension (HPT) and type 2 diabetes (T2D). We sought to summarize the burden of these three common NCDs among PLHIV in South Africa.

Methods: In this systematic review, multiple databases were searched for articles reporting on the prevalence of obesity, HPT, and T2D among PLHIV in South Africa published since journal inception until March 2022. A meta-analysis was conducted using random-effects models to obtain pooled prevalence estimates of the three NCDs. Heterogeneity was assessed using X2 test on Cochran's Q statistic.

Results: We included 32 studies, with 19, 22 and 18 studies reporting the prevalence of obesity, HPT, and T2D among PLHIV, respectively. The overall prevalence of obesity, HPT, and T2D was 23.2% [95% CI 17.6; 29.9], 25.5% [95% CI 15.6; 38.7], and 6.1% [95% CI 3.8; 9.7] respectively. The prevalence of obesity was significantly higher among women (P = 0.034) compared to men, however the prevalence of HPT and T2D did not differ by sex. The prevalence of each of the three NCDs did not differ significantly between rural, urban, and peri-urban areas. The prevalence of obesity and T2D was higher in studies conducted between 2013 and 2022 compared to studies conducted between 2000 and 2012, while the prevalence of HPT was higher between 2000 and 2012 compared to between 2013 and 2022.

Conclusions: These findings suggest that South Africa is experiencing a syndemic of NCDs among people PLHIV highlighting the need to increase cost-effective interventions and management strategies that involve integrated HIV and NCD care in the South African setting.

Keywords: Diabetes; Hypertension; Meta-analysis; Obesity; People living with HIV; Prevalence.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram depicting selection of included studies
Fig. 2
Fig. 2
Meta-analysis prevalence of obesity among people living with HIV in South Africa grouped by study period (2000–2012 and 2013–2022) CI: confidence interval. The vertical dotted line represents the overall prevalence, and the red diagonals represent the pooled prevalence in each group
Fig. 3
Fig. 3
Meta-analysis prevalence of obesity among people living with HIV in South Africa grouped by sex.CI: confidence interval. The vertical dotted line represents the overall prevalence, and the red diagonals represent the pooled prevalence for each sex
Fig. 4
Fig. 4
Meta-analysis prevalence of obesity among people living with HIV in South Africa grouped by setting (Urban, peri-urban, and rural areas) CI: confidence interval. The vertical dotted line represents the overall prevalence, and the red diagonals represent the pooled prevalence in each setting
Fig. 5
Fig. 5
Meta-analysis of prevalence of Hypertension among people living with HIV in South Africa grouped by study period (2000–2012 and 2013–2022) CI: confidence interval. The vertical dotted line represents the overall prevalence, and the red diagonals represent the pooled prevalence in each group
Fig. 6
Fig. 6
Meta-analysis of prevalence of Hypertension among people living with HIV in South Africa grouped by sex. CI: confidence interval. The vertical dotted line represents the overall prevalence, and the red diagonals represent the pooled prevalence for each sex
Fig. 7
Fig. 7
Meta-analysis of prevalence of Hypertension among people living with HIV in South Africa grouped by setting (rural, peri-urban, and urban areas) CI: confidence interval. The vertical dotted line represents the overall prevalence, and the red diagonals represent the pooled prevalence in each setting
Fig. 8
Fig. 8
Meta-analysis of prevalence of Type 2 diabetes among people living with HIV in South Africa grouped by study period (2000–2012 and 2013–2022) CI: confidence interval. The vertical dotted line represents the overall prevalence, and the red diagonals represent the pooled prevalence for each group
Fig. 9
Fig. 9
Meta-analysis of prevalence of Type 2 diabetes among people living with HIV in South Africa grouped by setting (rural, peri-urban, and urban areas) CI: confidence interval. The vertical dotted line represents the overall prevalence, and the red diagonals represent the pooled prevalence in each setting
Fig. 10
Fig. 10
Meta-analysis of prevalence of Type 2 diabetes among people living with HIV in South Africa grouped by sex. CI: confidence interval. The vertical dotted line represents the overall prevalence, and the red diagonals represent the pooled prevalence for each sex
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