Prevalence and incidence of hypertension and diabetes mellitus in HIV infected persons on HAART in Chongwe district in Lusaka province.

The Zambia National strategic plan (ZNHSP)-2011-2017 highlights the need for risk factor
stratification at the community level to form the basis of incidence and prevalence data, which
are currently inadequate. This research aims to determine the prevalence and incidence of
hypertension and diabetes among HIV infected patients on Highly Active Anti-Retroviral
Therapy (HAART) and its association with ARVs use. A retrospective cohort study was used
using the SMART CARE electronic database in Chongwe district to assess 2,070 HIV infected
persons on HAART. Data was analyzed using SPSS version 20, and analyzed using Chi-square
Kruskal-Wallis for analysis of variance, and logistic regression was used to establish the
determinants of hypertension and type II diabetes mellitus among HIV infected persons on
HAART. 33.8% HIV positive clients on HAART had hypertension, and an incident case fatality
rate of 85.7 cases per 1000 PYFU of hypertension. The prevalence of hypertension was
significantly higher (χ2=49.238, df=1; p<0.001) among men (64%) than among women (49%).
The prevalence of hypertension also differed significantly (χ2=11.194, df=2; p=0.004) among
different age categories and was highest (57.2%) among the 18-45 years age bracket. This study
also found a significant correlation between hypertension and age of client in years (p=0.009).
The study also found an incident rate of 37.4 cases per 1000 PYFU of T2DM. This study also
established no significant differences in the prevalence of type II diabetes mellitus between
women (26%) and men (23%). However, the prevalence of diabetes differed significantly
((χ2=10.043, df=2; p=0.007) among different age categories and was highest (27.5%) among the
56 years and older age bracket. Results of logistical regression analysis for the determinants
T2DM and hypertension show that ART combination (p=0.001), age category (p=0.011) and
cigarette smoking (p=0.0460) significantly added to the prediction model for T2DM outcome;
and that ART combination (p=0.004), sex (p=0.001), family history of hypertension (p=0.007)
and cigarette smoking (p=0.001) had significant associations with and significantly added to the
prediction model for hypertension outcome. HIV positive clients on HAART had high
prevalence and incidence of hypertension and type II diabetes mellitus. HAART combination
regimen of two NRTI classes plus either a PI or INSTI were associated with higher incidence of
hypertension whilst combination regimens of two NRTIs plus an NNRTI or INSTI and
combination therapy of NRTI+NNRTI+INSTI were associated with higher incidence of type II
diabetes mellitus in HAART treated clients.