| dc.description.abstract | Background: 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.
Methods: 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 individuallevel
data on one or more of the following traits in HIVþ and
HIV-, or ARTþ 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.
Results: Data were obtained from 49 published and 3 unpublished studies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 HIVþ 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.
Conclusions: 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. | en_US |
