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Dar es Salaam, Tanzania (March 9, 2017).

IHI Research Scientist Dr Kim Mwamelo presents findings of the study in Boston, US, last year at the Conference on Retroviruses and Opportunistic Infections. PHOTO/IHI

About 12 per cent of people living with HIV in rural Tanzania who are aged above 15 years have hypertension at the time of HIV diagnosis, according to findings of a new study conducted by Tanzania’s Ifakara Health Institute (IHI) in collaboration with partner institutions from Switzerland and Spain.

The new findings, published yesterday in the open-access journal PLOS ONE, also suggest that an additional 10 per cent of the studied group will develop hypertension during the first months of antiretroviral therapy (ART).

IHI research scientist, Dr. Kim Mwamelo, co-authored the paper along with Eduardo Rodríguez-Arbolí from Virgen del Rocío University Hospital, Seville, Spain. The two contributed equally to the work.

Other contributors are: Aneth Vedastus Kalinjuma from IHI, Hansjakob Furrer from the Department of Infectious Diseases, Bern University Hospital and University of Bern, Switzerland, and Christoph Hatz and Marcel Tanner all from the Swiss Tropical and Public Health Institute, Basel, and University of Basel, Switzerland.

In the list also are: Manuel Battegay from University of Basel, and Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland, and Emilio Letang from Swiss Tropical and Public Health Institute, University of Basel, Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, and ISGlobal, Barcelona Ctr. Int. Health Res, (CRESIB), Hospital Clinic – Universitat de Barcelona, Spain.

The research, amongst the first longitudinal studies looking at the development of hypertension in people living with HIV in sub-Saharan Africa, revealed that in a group of 955 HIV-infected people, 111 (11.6 per cent) were hypertensive at the time of HIV diagnosis.

Moreover, an additional 80 people (9.6 per cent) developed hypertension after initiation of ART. The incidence of hypertension found in this study after ART initiation is 1.5 times higher than the one observed in a large multinational study of Europe, the United States and Australia.

The study found that development of hypertension was not linked to the level of immunosuppression or any ART regimen in particular, but rather predicted by traditional cardiovascular risk factors such as age, body mass index and renal function. The effect of ART on body mass and the restoration of immunity are potential drivers of hypertension when under treatment.

The study was carried out at the Chronic Disease Clinic of Ifakara, within the Kilombero and Ulanga Antiretroviral Cohort (KIULARCO) in Morogoro Region. The other IHI partners in the study are: Swiss Tropical and Public Health Institute (Swiss TPH) based in Switzerland, University Hospital Basel, and Saint Francis Referral Hospital of Ifakara.

The study was conceived by Dr Letang (Swiss TPH and Barcelona Institute for Global Health), Dr. Eduardo Rodríguez-Arbolí (Virgen del Rocío University Hospital, Seville, Spain), and Dr. Kim Mwamelo (IHI). The KIULARCO Study Group developed and implemented it under the coordination of Dr. Letang.

More about the study

Many countries in sub-Saharan Africa face an unprecedented epidemic of both infectious and noncommunicable diseases. This ‘double burden of disease’ represents a major strain on already under-resourced health systems. Hypertension, in particular, is an independent, reversible risk factor for cardiovascular, cerebrovascular and renal disease, affecting mortality, yet, the disease remains largely undiagnosed and undertreated in sub-Saharan Africa.

Hypertension and other non-communicable diseases share a number of similarities with HIV, such as the chronic evolution of disease and the need for regular follow-up and optimal treatment adherence. The study therefore suggests integrating routine hypertension screening in HIV clinics.

“We have seen that such routine screening is a feasible and effective strategy to diagnose hypertension within an HIV programme”, said Dr Emilio Letang. “Moving forward, however, we need to make sure that leveraging such synergies does not compromise the efficiency of existing HIV programmes.”

The study also urges expansion of access to antihypertensive medicines. “In many countries across sub-Saharan Africa, there is still a lack of access to drugs against major non-communicable diseases,” said Prof Christoph Hatz, Chief Medical Officer at Swiss TPH. “In order for such integrated care programmes to work successfully, ensuring better availability and affordability of drugs as well as implementing comprehensive preventive and curative measures will be key.” Learn more about the Chronic Disease Clinic in Ifakara (CDCI) here: http://ihi.or.tz/office-location/ifakara/

About the paper and the publication

Title: Incidence and Predictors of Hypertension among HIV Patients in Rural Tanzania – a Prospective Cohort Study

Author(s): Eduardo Rodríguez-Arbolí*, Kim Mwamelo*, Aneth Vedastus Kalinjuma, Hansjakob Furrer, Christoph Hatz, Marcel Tanner, Manuel Battegay and Emilio Letang.

*Equal contribution

Journal: PLOS ONE

Date of Publication:  March 8, 2017

Contact

Dr. Kim Mwamelo, Ifakara Health Institute (IHI), mwamelok@gmail.com

Dr. Emilio Letang, MD, MPH, PhD, former Head of the Chronic Disease Clinic in Ifakara (CDCI), current Scientific Collaborator at Swiss Tropical and Public Health Institute (Swiss TPH) and Assistant Research Professor at Barcelona Institute for Global Health (ISGlobal), Tel. +34 93 227 5400 Ext. 2982, emili.letang@unibas.ch

Prof Christoph Hatz, Chief Medical Officer, Swiss Tropical and Public Health Institute (Swiss TPH), +41 61 284 81 11, christoph.hatz@unibas.ch

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