# Beyond viral load: Unravelling non-communicable disease patterns in Manicaland province, Zimbabwe

## TL;DR

This study examines non-communicable diseases in people living with HIV in Zimbabwe, finding that hypertension and diabetes are most common and linked to aging and long-term HIV treatment.

## Contribution

The study identifies specific HIV treatment regimens that increase or reduce risks of NCDs like diabetes and hypertension.

## Key findings

- Hypertension and diabetes are the most prevalent NCDs among people living with HIV in Manicaland.
- Being on ART for more than 5 years and aging increase the risk of diabetes and hypertension.
- Efavirenz-based regimens protect against hypertension, while protease inhibitors increase diabetes risk.

## Abstract

Non-communicable diseases (NCDs) among people living with human immunodeficient virus (HIV) are emerging and a leading cause of death in this population.

To identify disease trends, prevalence and outcomes of NCDs among PLHIV.

The study was conducted in Manicaland province.

We reviewed secondary data from October 2013 to September 2023. Data on five priority NCDs were analysed: hypertension (HPT), diabetes mellitus (DM), chronic kidney injury (CKD), cancers and chronic respiratory conditions (CRC). Kaplan–Meier analysis and Cox proportional hazard analysis were performed, risk and hazard ratios reported at the 95% confidence level.

A total of 974 patient files were reviewed. The median age was 43 (Q1 = 35; Q3 = 51) years. A total of 409 (42.0%) were males and 565 (58.0%) were females. A total of 94 (9.7%) patients had HPT, 76 (7.8%) had DM, 6 (0.6%) had CKD, 9 (0.9%) had cancer and 3 (0.3%) had CRC. Controlling for age, gender and medication use, being on ART for more than 5 years and ageing were hazards to DM and HPT. Protease inhibitor-based regimen was a hazard to DM (hazard ratio [HR] = 4.66, 95% CI: 2.54–8.54, p < 0.001). Efavirenz-based regimen was protective in development of HPT (HR = 0.47, 95% CI: 0.26–0.83), p = 0.01.

Hypertension and DM are the most common NCDs among people living with HIV. Prevalence of HPT and DM increased with age and duration on ART. To minimise complications related to NCD and HIV comorbidities, we recommend regular screening of NCDs at least monthly, and personalising treatment for hypertensive patients to efavirenz based regimens. We educated people living with HIV about the risks of NCDs and importance of healthy eating and regular exercise.

Integrated NCD and HIV care models.