ASSOCIATION BETWEEN USE OF HAART AND THE DEVELOPMENT OF HYPERTENSION AMONG PLWHIV

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ASSOCIATION BETWEEN USE OF HAART AND THE DEVELOPMENT OF HYPERTENSION AMONG PLWHIV

CHAPTER ONE

INTRODUCTION

Background of the study

HIV is a major public health problem in the world today. In 2015, 2.1 million new HIV infections were recorded worldwide, adding up to a total of 36.7 million people living with HIV in the world. About 1.1 million people died of AIDS-related illnesses worldwide. Although the burden of the epidemic continues to vary considerably between countries and regions, sub Saharan Africa remains the most severely affected with 4.4% of persons living with HIV. This percentage accounts for nearly 70% of the people living with HIV worldwide. Countries in west Africa have a significantly lower prevalence rates as their populations typically engage in fewer high risk cultural patterns that have been implicated in the spread of the virus in sub Saharan Africa (SSA) [1]. The number of people living with HIV in Nigeria is estimated to about 620,000 (UNAIDS). Adults aged 15 and above living with HIV are 580,000, adults aged from 1549 have a prevalence rate of 4.5%. Women aged 15 and above living with HIV is 340,000 and the number of death due to AIDS in Nigeria is 33,000 [1]. Since the introduction of Highly Active Antiretroviral Therapy (HAART), in the mid-1990s, the number of people living with HIV and under antiretroviral therapy has increased by about a third in the last 2 years; reaching 17.0 million people compared to the 15 million that was targeted in 2015 by the United Nations General Assembly in 2011. Since the first global treatment target was set in 2003, annual AIDS-related deaths have decreased by 43% [1]. In the world’s most affected region, eastern and southern Africa, the number of people on treatment has more than doubled since 2010, reaching nearly 10.3 million people. AIDS related deaths in the region have decreased by 36% since 2010 [1]. HIV-related morbidity and mortality rates have dropped remarkably since the introduction of HAART. Whereas concerns of a link between HAART and coronary heart disease (CHD) have increased. An elevated risk of myocardial infarction among people taking HAART has been found in some studies. Investigators have assessed the relationship between the uses of antiretroviral therapy (ART) and components of the metabolic syndrome including dyslipidemia [2], insulin resistance [1, 2] and abnormal fat distribution [3]. Despite the scarcity of data on cardiovascular diseases (CVD) in people living with HIV in Africa, a study estimates the prevalence of self-reported CVD risk factors in HIV patients in Africa at 12% [4].

In Uganda, about 18% of HIV-infected adults were found with subclinical atherosclerosis which can be predictive of CVD [5]. Recent data suggest that cardiovascular diseases such as heart failure, coronary artery diseases hypertension and stroke are common and appear to be very frequent in HIV infected population in low and middle income countries [5, 6]. HAART and especially protein inhibitors (PIs) seem to be associated with metabolic dysfunction and could increase the risk of cardiovascular events [6]. Recent reports raise increasing suspicion that HAART may also induce hypertension [7-11]. Conflicting results have been reported for the association between HAART and blood pressure and for the association between HAART and the prevalence of hypertension [12, 13]. The relationship between HAART and hypertension has not been well studied [13]. Hypertension appears to be linked to insulin resistance; in particular, hypertension seems to be a part of the metabolic syndrome [14]. Interestingly, increase blood pressure has been found to be associated with lipodystrophy [13]; providing thus additional evidence that HAART and hypertension may be linked via pathways involving lipodystrophy or other metabolic disorders [15]. The association between HAART and hypertension has been documented elsewhere [7-13]. Due to the conflicting results between HAART and hypertension and the lack of data on this subject in the North West region of Nigeria, there is a need to improve our knowledge on the impact of HAART on the possible development of side effects such as hypertension in people living with HIV (PLWHIV) and under ART. This study was carried out with the aim to identify side effects resulting from ART in order to improve the control of HIV/AIDs by putting at the disposal of policy makers and stakeholders’ information that could help them to ameliorate the treatment of PLWHIV.

Statement of the problem

There may have been previous researches in this subject. This work gives further explanations and analysis in association between use of haart and the development of hypertension among plwhiv

Objectives of the study
To understand the impact of use of haart on the development of hypertension among plwhiv
To understand the relationship between association between use of haart and the development of hypertension among plwhiv

Research questions

What is the impact of use of haart on the development of hypertension among plwhiv
What is the relationship between association between use of haart and the development of hypertension among plwhiv