Hypertension in People Living with HIV (PLHIV): A Comparative Analysis Before and After Test-and-Treat Policy Implementation
Abstract
Background
The universal test-and-treat (T&T) policy has improved HIV outcomes but may influence hypertension (HTN) risk due to prolonged antiretroviral therapy (ART) exposure. We compared HTN prevalence and risk factors among PLHIV before and after T&T implementation in Zambia.
Methods
A retrospective cohort study analyzed 6,409 PLHIV (2,920 pre-T&T and 3,489 post-T&T) from 12 Southern Province districts. Data on demographics, ART regimens, blood pressure, and laboratory measures were extracted from electronic (SmartCare) and paper records. Multivariable logistic regression identified HTN-associated factors (p<0.05).
Results
HTN prevalence increased from 8.8% pre-T&T to 10.2% post-T&T. Each year of age increased HTN odds by 5–6% in both cohorts (adjusted odds ratio [AOR]: 1.06 pre-T&T, 1.05 post-T&T p<0.0001). Urban residence was protective (AOR: 0.72 pre-T&T, 0.67 post-T&T p≤0.041), while males had higher HTN risk than females (12.2% vs. 8.8% post-T&T p=0.0015). Post-T&T, higher hemoglobin marginally increased HTN odds (AOR: 1.08; p=0.049). INSTI-based regimens rose from 26.3% to 41.5% post-T&T but showed no significant association with hypertension on multivariate analysis. Rural residents had higher HTN prevalence (11.5% vs. 8.4% urban post-T&T p=0.0027).
Conclusions
HTN prevalence increased post-T&T, and was driven by aging and potentially ART-related metabolic effects. Urban residence was unexpectedly protective, possibly due to better healthcare access. The hemoglobin-HTN link post-ART warrants further study. Strengths include a large, representative sample, though unmeasured confounders (e.g., lifestyle factors) and retrospective design limit causal inferences. Integrated HTN screening in HIV programs is critical to address this growing burden.
Related articles
Related articles are currently not available for this article.