HIV-hypertension treatment outcomes among adults on antiretroviral therapy in two states in Northern and Southern Nigeria: a cross-sectional design approach

Abstract

Background: The combined effect of the aging human immunodeficiency virus (HIV) population, HIV’s natural progression, and HIV drugs have great implications for comorbidity burden and hypertension control among people living with HIV (PLHIV). Objectives: This study assessed hypertension burden, treatment outcomes, and treatment outcome predictors among PLHIV in Nigeria. Design: Cross-sectional design. Methods: A cross-sectional study of 2613 adult PLHIV who initiated antiretroviral therapy (ART) between 2004 and 2020 in two HIV clinics in Northern and Southern Nigeria. Study outcomes were: (1) controlled blood pressure defined as two consecutive blood pressure (BP) measurements of <140/90 mmHg (Joint National Committee guideline (JNC) 7) on the interview day in previously diagnosed hypertensive participants; and (2) HIV viral suppression defined as recent viral load count of <1000 copies/ml in a hypertensive participant. Data were analyzed using Statistical Package of Social Sciences IBM version 23. Univariate and multivariate logistic regression was done to ascertain factors associated with the study outcomes at p < 0.05. Result: The mean age of respondents at the point of the study was 45.3 ± 9.8 years. Most of the participants were female, 1940 (74.2%), on a dolutegravir-based therapy, 2433 (93.2%). About 452 (17.3%) of the participants had clinically diagnosed hypertension. Of those diagnosed hypertensives, 443 (98.0%) were on antihypertensive drugs. About 407 (90.0%) and 229 (51.7%) of the hypertensive PLHIV had HIV viral suppression and controlled hypertension respectively. Factors associated with controlled hypertension were age at ART initiation (adjusted odds ratio (AOR): 0.96, 95% CI: 0.94–0.98), use of thiazide only antihypertensive (AOR: 1.91, 95% CI: 1.73–3.24, Ref: calcium channel blocker only) and thiazide-calcium channel blocker combination (AOR: 2.19, 95% CI: 1.05–4.58). No hypertension comorbidity-related factors were found to be associated with HIV viral suppression. Conclusion: There is suboptimal hypertension control among hypertensive PLHIV especially those on non-thiazide-based antihypertensive drugs. Close monitoring should be given to hypertension management in PLHIV.