title: Population-level decline in BMI and systolic blood pressure following mass HIV treatment: Evidence from rural KwaZulu-Natal.
abstract: Clinic-based studies have shown that patients with human immunodeficiency virus (HIV) gain weight after initiation of antiretroviral therapy (ART). This study aimed to determine whether the scale-up of ART was associated with a population-level increase in body mass index (BMI) and blood pressure (BP) in a community with high HIV and obesity prevalence.
  
  
  
  A household survey was conducted in rural KwaZulu-Natal before ART scale-up (in 2004) and when ART coverage had reached 25% (in 2010). Anthropometric data was linked with HIV surveillance data.
  
  
  
  Mean BMI decreased in women from 29.9 to 29.1 kg/m2(P = 0.002) and in men from 24.2 to 23.0 kg/m2(P < 0.001). Similarly, overweight and obesity prevalence declined significantly in both sexes. Mean systolic BP decreased from 123.0 to 118.2 mm Hg (P < 0.001) among women and 128.4 to 123.2 mm Hg (P < 0·001) among men.
  
  
  
  Large-scale ART provision is likely to have caused a decline in BMI at the population level, because ART has improved the survival of those with substantial HIV-related weight loss. The ART scale-up may have created an unexpected opportunity to sustain population-level weight loss in communities with high HIV and obesity prevalence though targeted lifestyle and nutrition interventions.
authors.affiliation: Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
authors.forename: Pascal
authors.initials: P
authors.lastname: Geldsetzer
authors.affiliation: Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.|Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Andrea B
authors.initials: AB
authors.lastname: Feigl
authors.affiliation: Africa Health Research Institute, Mtubatuba, South Africa.|Institute of Epidemiology and Health Care, University College London, London, UK.
authors.forename: Frank
authors.initials: F
authors.lastname: Tanser
authors.affiliation: Africa Health Research Institute, Mtubatuba, South Africa.
authors.forename: Dickman
authors.initials: D
authors.lastname: Gareta
authors.affiliation: Africa Health Research Institute, Mtubatuba, South Africa.|Institute of Epidemiology and Health Care, University College London, London, UK.
authors.forename: Deenan
authors.initials: D
authors.lastname: Pillay
authors.affiliation: Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.|Africa Health Research Institute, Mtubatuba, South Africa.|Institute of Public Health, Faculty of Medicine, Heidelberg University, Heidelberg, Germany.
authors.forename: Till
authors.initials: T
authors.lastname: Bärnighausen
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D001794:Blood Pressure; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology*; D050177:Overweight / Q000453:epidemiology*; D015995:Prevalence; D012424:Rural Population; D013019:South Africa / Q000453:epidemiology; D015430:Weight Gain
chemical_list: D044966:Anti-Retroviral Agents