ART programs may promote greater utilization of healthcare services for co-morbid diabetes and hypertension, but the implications of this relationship for blood pressure (BP) and glycemic control remain unclear. In this study, we sought to assess whether the ‘ART advantage’ extends to improved blood pressure and glucose measures among participants with these conditions.
This study was conducted using baseline data from Health and Aging in Africa: a Longitudinal Study of an INDEPTH Community in South Africa (HAALSI). HAALSI is a cohort of 5,059 adults aged 40+ in rural South Africa. Participants in HAALSI were randomly sampled and surveyed between November 2014 and November 2015. Height, weight, BP, blood glucose and HIV infection parameters, including viral load (VL) and ART drug levels, were collected on all consenting participants. Healthcare utilization was self-reported. We first fit log binomial regression models to examine the association between stage in the HIV care cascade ([1] HIV-, [2] HIV+/No ART, [3] ART/Detectable VL, and [4] ART/Suppressed VL) and diagnosis, treatment and control of hypertension or diabetes. We then used linear regression models to estimate differences in systolic BP and blood glucose among those with diagnosed hypertension or diabetes. In all regression models, we controlled for age, sex, BMI, education and wealth; the model for blood glucose was additionally adjusted for fasting status.
In this cohort, ART/Suppressed VL was associated with greater awareness of hypertension diagnosis [adjusted risk ratio (aRR) 1.21, 95% CI: 1.10 – 1.32] and treatment of hypertension [aRR 1.25, 95% CI: 1.09 – 1.44] among those who met criteria for a diagnosis of hypertension, compared to being HIV-. There were no significant relationships between stage in the HIV care cascade and awareness of diagnosis or treatment of diabetes. Among those with diagnosed hypertension or diabetes, ART/Suppressed VL was associated with lower mean systolic BP [-5.94 mm Hg, 95% CI: -9.68 – -2.20] and lower mean glucose [-3.74 mmol/L, 95% CI: -5.95 – -0.58], compared to being HIV-.
Progression in the HIV care cascade was associated with improved clinical hypertension and diabetes control. HIV treatment programs may provide a platform for health systems strengthening for cardiometabolic disease. Future studies are needed to assess the causality and mechanisms that underlie ART program use and control of cardiometabolic conditions.