title: Cardiometabolic disease risk and HIV status in rural South Africa: establishing a baseline.
abstract: BACKGROUND
  To inform health care and training, resource and research priorities, it is essential to establish how non-communicable disease risk factors vary by HIV-status in high HIV burden areas; and whether long-term anti-retroviral therapy (ART) plays a modifying role.
  
  
  METHODS
  As part of a cohort initiation, we conducted a baseline HIV/cardiometabolic risk factor survey in 2010-2011 using an age-sex stratified random sample of ages 15+ in rural South Africa. We modelled cardiometabolic risk factors and their associations by HIV-status and self-reported ART status for ages 18+ using sex-stratified logistic regression models.
  
  
  RESULTS
  Age-standardised HIV prevalence in women was 26% (95% CI 24-28%) and 19% (95% CI 17-21) in men. People with untreated HIV were less likely to have a high waist circumference in both women (OR 0.67; 95% CI 0.52-0.86) and men (OR 0.42; 95% CI 0.22-0.82). Untreated women were more likely to have low HDL and LDL, and treated women high triglycerides. Cardiometabolic risk factors increased with age except low HDL. The prevalence of hypertension was high (40% in women; 30% in men).
  
  
  CONCLUSIONS
  Sub-Saharan Africa is facing intersecting epidemics of HIV and hypertension. In this setting, around half the adult population require long-term care for at least one of HIV, hypertension or diabetes. Together with the adverse effects that HIV and its treatment have on lipids, this may have serious implications for the South African health care system. Monitoring of the interaction of HIV, ART use, and cardiometabolic disease is needed at both individual and population levels.
authors.affiliation: MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. work@samclark.net.|Institute of Behavioral Science, University of Colorado Boulder, Boulder, USA. work@samclark.net.|School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. work@samclark.net.|INDEPTH Network, Accra, Ghana. work@samclark.net.|Department of Sociology, University of Washington, Seattle, USA. work@samclark.net.
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Clark
authors.affiliation: MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. F.Gomez-OliveCasas@wits.ac.za.|INDEPTH Network, Accra, Ghana. F.Gomez-OliveCasas@wits.ac.za.
authors.forename: F Xavier
authors.initials: FX
authors.lastname: Gómez-Olivé
authors.affiliation: MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. brian.houle@anu.edu.au.|Institute of Behavioral Science, University of Colorado Boulder, Boulder, USA. brian.houle@anu.edu.au.|Australian Demographic and Social Research Institute, Australian National University, Canberra, Australia. brian.houle@anu.edu.au.
authors.forename: Brian
authors.initials: B
authors.lastname: Houle
authors.affiliation: MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. m.thorogood@warwick.ac.uk.|School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. m.thorogood@warwick.ac.uk.|Division of Health Sciences, University of Warwick Medical School, Coventry, UK. m.thorogood@warwick.ac.uk.
authors.forename: Margaret
authors.initials: M
authors.lastname: Thorogood
authors.affiliation: School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. K.Klipstein-Grobusch@umcutrecht.nl.|Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands. K.Klipstein-Grobusch@umcutrecht.nl.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Klipstein-Grobusch
authors.affiliation: MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. angotti@american.edu.|Institute of Behavioral Science, University of Colorado Boulder, Boulder, USA. angotti@american.edu.|School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. angotti@american.edu.|Department of Sociology and Center on Health, Risk, and Society, American University, Washington, DC, USA. angotti@american.edu.
authors.forename: Nicole
authors.initials: N
authors.lastname: Angotti
authors.affiliation: MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. Chodziwadziwa.Kabudula@wits.ac.za.|INDEPTH Network, Accra, Ghana. Chodziwadziwa.Kabudula@wits.ac.za.
authors.forename: Chodziwadziwa
authors.initials: C
authors.lastname: Kabudula
authors.affiliation: Institute of Behavioral Science, University of Colorado Boulder, Boulder, USA. jill.williams@colorado.edu.|School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. jill.williams@colorado.edu.
authors.forename: Jill
authors.initials: J
authors.lastname: Williams
authors.affiliation: Institute of Behavioral Science, University of Colorado Boulder, Boulder, USA. jane.menken@colorado.edu.|School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. jane.menken@colorado.edu.
authors.forename: Jane
authors.initials: J
authors.lastname: Menken
authors.affiliation: MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. Stephen.Tollman@wits.ac.za.|School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. Stephen.Tollman@wits.ac.za.|Centre for Global Health Research, Umeå University, Umeå, Sweden. Stephen.Tollman@wits.ac.za.|INDEPTH Network, Accra, Ghana. Stephen.Tollman@wits.ac.za.
authors.forename: Stephen
authors.initials: S
authors.lastname: Tollman
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006679:HIV Seropositivity / Q000453:epidemiology*; D006304:Health Status; D006801:Humans; D016015:Logistic Models; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology*; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data; D057566:Self Report; D013019:South Africa / Q000453:epidemiology; D055815:Young Adult