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

BackgroundHigh 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.MethodsIn 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–+ART0–; 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.ResultsBetween 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- than in HIV+ART2–5yrs (p = 0.005). DID in BMI in HIV+ART0- 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).ConclusionShort-term ART (0–- population. Our results showcase the importance of health system readiness to address the burgeoning double burden of disease in South Africa.研究背景：在南非，高身体质量指数（Body Mass Index, BMI）与血压升高是主要的慢性病危险因素。目前学界对人类免疫缺陷病毒（Human Immunodeficiency Virus, HIV）和抗逆转录病毒治疗（Antiretroviral Therapy, ART）对体脂与血压的长期影响尚不清楚，且针对HIV阴性（HIV-）与HIV阳性（HIV+）人群的危险因素轨迹开展直接比较的研究较为罕见。 研究方法：本研究于2003年与2010年，在南非夸祖鲁-纳塔尔省的研究队列（总样本量n=505，成人HIV感染率为30%）中记录了受试者的身高、体重与血压（Blood Pressure, BP）。我们对以下亚组人群的BMI与BP纵向变化进行了建模分析：HIV阴性个体（n=315）、血清转换者（seroconverters, n=32）、未接受抗逆转录病毒治疗的HIV阳性患者（HIV+ART−, n=52）、接受抗逆转录病毒治疗时长为0–+ART0–的HIV阳性患者（n=18）、接受抗逆转录病毒治疗2–5年的HIV阳性患者（HIV+ART2–5yrs, n=44），以及HIV感染状态未知的亚组人群（n=44）。本研究以HIV阴性人群为参照组，评估了双重差分法（Difference-in-differences, DID）的分析结果。 研究结果：2003年至2010年间，HIV阴性组的BMI显著升高0.874（95%置信区间CI：0.339~1.41；p=0.001），最终均值达到30.4。HIV+ART0–组的BMI下降幅度显著大于HIV+ART2–5yrs组（p=0.005）。以HIV阴性人群为参照，HIV+ART0–组的BMI双重差分结果为-5.21（95%CI：-7.53~-2.90；p=0.001），HIV+ART2–5yrs组的BMI双重差分结果为-1.35（95%CI：-2.89~0.189；p=0.086）。未接受抗逆转录病毒治疗的HIV阳性患者相较于HIV阴性人群的收缩压（Systolic Blood Pressure, SBP）双重差分结果为-7.55mmHg（95%CI：-13.2~-1.90；p=0.009）。 研究结论：短期抗逆转录病毒治疗（0–- 人群）。本研究结果凸显了南非卫生系统做好准备以应对日益严峻的双重疾病负担的重要性。