Association between HIV infection and hypertension: A global systematic review and meta-analysis of cross-sectional studies

Background: Improved access to effective antiretroviral therapy has meant that people living with HIV (PLHIV) are
surviving to older ages. However, PLHIV may be ageing differently to HIV-negative individuals, with dissimilar
burdens of non-communicable diseases, such as hypertension. While some observational studies have reported a
higher risk of prevalent hypertension among PLHIV compared to HIV-negative individuals, others have found a
reduced burden. To clarify the relationship between HIV and hypertension, we identified observational studies and
pooled their results to assess whether there is a difference in hypertension risk by HIV status.
Methods: We performed a global systematic review and meta-analysis of published cross-sectional studies that
examined hypertension risk by HIV status among adults aged > 15 (PROSPERO: CRD42019151359). We searched
MEDLINE, EMBASE, Global Health and Cochrane CENTRAL to August 23, 2020, and checked reference lists of
included articles. Our main outcome was the risk ratio for prevalent hypertension in PLHIV compared to HIVnegative individuals. Summary estimates were pooled with a random effects model and meta-regression explored
whether any difference was associated with study-level factors.
Results: Of 21,527 identified studies, 59 were eligible (11,101,581 participants). Crude global hypertension risk was
lower among PLHIV than HIV-negative individuals (risk ratio 0.90, 95% CI 0.85–0.96), although heterogeneity
between studies was high (I² = 97%, p < 0.0001). The relationship varied by continent, with risk higher among PLHIV
in North America (1.12, 1.02–1.23) and lower among PLHIV in Africa (0.75, 0.68–0.83) and Asia (0.77, 0.63–0.95). Metaregression revealed strong evidence of a difference in risk ratios when comparing North American and European
studies to African ones (North America 1.45, 1.21–1.74; Europe 1.20, 1.03–1.40).
Conclusions: Our findings suggest that the relationship between HIV status and prevalent hypertension differs by
region. The results highlight the need to tailor hypertension prevention and care to local contexts and underscore
the importance of rapidly optimising integration of services for HIV and hypertension in the worst affected regions.
The role of different risk factors for hypertension in driving context-specific trends remains unclear, so development
of further cohorts of PLHIV and HIV-negative controls focused on this would also be valuable.

• Population(s)
  • General HIV+ population
• Co-morbidities
  • Cardiovascular