To our knowledge, this is the first study in eastern Africa reporting the prevalence of hypertension in males and females outpatients treated in urban and rural areas for HIV infection. The main result and strong message of our study is the very high prevalence of HTN in PLWH despite the young age (almost 20%) whom almost one half are unaware of their condition. The prevalence of 17.5% in our population is comparable to those reported in Ethiopia (17.1%), South Africa (19.1%) and Malawi (19.5%)17–19, but lower than those reported in Cameroon (38.6%), Tanzania (28.7%), Senegal (28.1%) and Uganda(27.9%)20–23.
The disparity in prevalence of HTN among different sub- Saharan African countries may be related for several reasons, including genetic and socioeconomic conditions, the duration and clinical stages of HIV, the types of ART therapy and the selected study population (e.g. hospitalized vs. outpatients).
Long-term antiretroviral treatment, the chronic inflammation and the immune activation associated with HIV infection, even if successfully treated, as well as the co-existence of some traditional cardiovascular risk factors expose subjects living with HIV to various morphological and metabolic disturbances, including features of the metabolic syndrome. This partly explains the increased risk of CV disease described in the population living with HIV.
Several studies demonstrated that possible risk factors of hypertension in HIV-infected population are older age, male gender, family history of HTN, longer duration of HIV infection, low CD4 count, high viral burden, high body mass index and certain medications combined with ART24–26. Divala and al. in their study about cardiovascular risk factors among adult Malawians in HIV found that hypertension was related with increasing age, diabetes and higher body mass index 27,28.
The pathophysiology leading to cardiovascular disease in HIV infected patients is still controversial. Animals studies suggested that a systemic inflammatory process and the activation of the adaptive immune systems would contribute to the development of HTN 29–31.
In our study HTN appears to be related to age, overweight and obesity, diabetes, duration of HIV and the combined antiretroviral therapy for more than 5 years.
In our study, there was no relevant association between HTN and gender or smoking. This might be due to the general low percentage of current smokers in African country. Also, the majority of our study population were women.
Compared prevoius heterogeneous studies 27,32,33 we do not repport HTN prevalence diffrenecs between urban and rural areas.
Duration on ART and types of ART were reported, especially protease inhibitors 34–36. No association was found in our study. This is possibly because Burundi run new protocol since july 2019 in order to rapidly advance the next set of 2030 AIDS goals: 95% of people living with HIV aware of their HIV status; 95% on treatment; and 95% of people on treatment with suppressed viral loads. The new recommendations of WHO switching to dolutegravir into first-line in settings where resistance to non-nucleoside reverse transcriptase inhibitors (NNRTIs) is rising 37.
Our main study limitation is due to the cross-sectional design. Our study is not able to determine chronologically the relationships between HTA and associated factors. Also, by lack of data in Burundian population, our study do not compare HTN prevalence among HIV infected patients (17.4%) to the HTN prevalence in general population. Definition of HTN was limited to “one shot” measures as ambulatory or home blood pressure measurements are unavailable in Brundi.