Global burden of hypertension among people living with HIV in the era of increased life expectancy: a systematic review and meta-analysis

Background: Although HIV infection and antiretroviral therapy (ART) increase the risk for hypertension in people living with HIV (PLHIV), the global and regional burden of hypertension in PLHIV is not well characterized. Methods: In this systematic review and meta-analysis, we searched multiple databases for studies reporting on hypertension in PLHIV and conducted between 2007 and 2018. Meta-analysis through random-effect models served to obtain the pooled prevalence estimates. Heterogeneity was assessed via the chi(2)test on Cochran's Q statistic. Results: We included 194 studies (396 776 PLHIV from 61 countries). The global prevalence of hypertension was 23.6% [95% confidence interval (95% CI: 21.6-25.5)] with substantial heterogeneity. The regional distribution was Western and Central Europe and North America [28.1% (95% CI: 24.5-31.9)], West and Central Africa [23.5% (16.6-31.0)], Latin America and the Caribbean [22.0% (17.8-26.5)], Eastern and Southern Africa [19.9% (17.2-22.8)], and Asia and Pacific [16.5% (12.5-21.0)];P = 0.0007. No study originated from the Middle East and North Africa, and Eastern Europe and Central Asia regions. The prevalence was higher in high-income countries than others (P = 0.0003) and higher in PLHIV taking ART than those ART-naive (P = 0.0003). The prevalence increased over time (mainly driven by Eastern and Southern Africa) and with age. There was no difference between men and women. We estimated that in 2018, there were 8.9 (95% CI: 8.3-9.6) million cases of hypertension in PLHIV globally, among whom 59.2% were living in Sub-Saharan Africa. Conclusion: Cost-effective strategies to curb the dreadful burden of hypertension among PLHIV are needed.