The association between antiretroviral therapy and selected cardiovascular disease risk factors in sub-Saharan Africa: A systematic review and meta-analysis

BACKGROUND: With increasing adverse cardiovascular disease (CVD) outcomes in HIV/AIDS patients, the possible contribution of antiretroviral therapy (ART) to the prevailing CVD epidemic in sub-Saharan Africa (SSA) through its effect on CVD risk factors has rather been under investigated. This study aimed to assess the extent to which ART is associated with hypertension, diabetes mellitus (DM) and dyslipidemia in SSA. METHODS: This is a systematic review and meta-analysis of studies from SSA, published between January 1946 and December 2017, from Medline, Embase, Africa-wide Information, the Cochrane library, African Index and Medicus databases. Both observational and interventional studies with comparable ART-treated and ART-naïve populations were selected and data was extracted from eligible studies. Pooled estimates of the effect of ART on the outcomes of interest (hypertension, diabetes and abnormal lipid profiles) were obtained using random effects meta-analysis, and meta-regression analysis was used to explore between-study heterogeneity. RESULTS: Twenty cross-sectional studies were included involving 5386 participants. There was no association between ART use and hypertension (OR: 1.9, 95%CI: 0.96–3.76, n = 8, I(2) = 73.8%) and DM (OR: 2.53, 95%CI: 0.87–7.35, n = 8, I(2) = 73.8%). ART use was associated with high total cholesterol (OR: 3.85, 95%CI: 2.45–6.07, n = 8, I(2) = 67.0%), high triglycerides (OR: 1.46, 95%CI: 1.21–1.75, n = 14, I(2) = 10.0%) and high LDL-cholesterol (OR: 2.38, 95%CI: 1.43–3.95, n = 11, I(2) = 87.6%). ART was associated with rather lower odds of having low HDL-cholesterol (OR: 0.53, 95%CI: 0.32–0.87, n = 8, I(2) = 78.2%). There was evidence of between-study heterogeneity for all outcomes except high triglycerides. CONCLUSIONS: ART appears to be associated with CVD risk in HIV/AIDS patients in SSA only through dyslipidemia but not through hypertension and DM, however, high quality and robust research in SSA is mandated to accurately ascertain the actual contribution of ART to the CVD burden in this part of the world. Nevertheless, HIV/AIDS patients should still benefit from systematic CVD screening alongside their regular care services. TRIAL REGISTRATION: Prospero Registration - CRD42016042306.