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Prevalence of Metabolic Syndrome, Discrete Or Comorbid Diabetes And Open Access Protocol BMJ Open: first published as 10.1136/bmjopen-2017-016602 on 9 July 2017. Downloaded from Prevalence of metabolic syndrome, discrete or comorbid diabetes and hypertension in sub-Saharan Africa among people living with HIV versus HIV-negative populations: a systematic review and meta-analysis protocol Olamide O Todowede,1 Benn Sartorius2 To cite: Todowede OO, ABSTRACT Strengths and limitations of this study Sartorius B. Prevalence of Introduction Metabolic disorder and high blood pressure metabolic syndrome, discrete are common complications globally, and specifically or comorbid diabetes and ► Understanding the differences in the burden of among people living with HIV (PLHIV). Diabetes, metabolic hypertension in sub-Saharan metabolic syndrome (and its subcomponents), Africa among people living syndrome and hypertension are major risk factors for diabetes and hypertension between HIV-positive and with HIV versus HIV-negative cardiovascular diseases and their related complications. HIV-negative populations. However, the burden of metabolic syndrome, discrete or populations: a systematic ► This review contributes to informing public health review and meta-analysis comorbid diabetes and hypertension in PLHIV compared actions needed for non-communicable disease protocol. BMJ Open with HIV-negative population has not been quantified. (NCD) comorbidities and population health. 2017;7:e016602. doi:10.1136/ This review and meta-analysis aims to compare and Stringent adherence to the Preferred Reporting bmjopen-2017-016602 ► analyse the prevalence of these trio conditions between Items for Systematic Reviews and Meta-Analysis HIV-negative and HIV-positive populations in sub-Saharan ► Prepublication history and Statement guidelines. Africa (SSA). additional material are available. ► Inclusion of non-English-language (French) To view these files please visit Methods and analysis The Preferred Reporting Items published studies and literature to increase the http://bmjopen.bmj.com/ the journal online (http:// dx. doi. for Systematic Reviews and Meta-Analysis statement representativeness of the findings in the region. org/ 10. 1136/ bmjopen- 2017- guides the methods for this study. Eligibility criteria A limitation is the lack of single definition criteria 016602). ► will be published original articles (English and French of metabolic syndrome over the study period; thus, language) from SSA that present the prevalence of Received 27 February 2017 hypertension and diabetes are inclusive of the metabolic syndrome, discrete and/or comorbid diabetes, Revised 12 April 2017 subcomponents. Accepted 21 April 2017 and hypertension comparisons between PLHIV and HIV- negative populations. The following databases will be searched from January 1990 to February 2017: PubMed/ Medline, EBSCOhost, Web of Science, Google Scholar, parasitic diseases will decrease, while chronic on September 24, 2021 by guest. Protected copyright. Scopus, African Index Medicus and Cochrane Database of and ageing-related conditions and diseases Systematic Reviews. Eligibility screening and data extraction will increase, these changes being driven by will be conducted independently by two reviewers, and social factors and lifestyles.1 2 The generali- disagreements resolved by an independent reviewer. Methodological quality and risk of bias will be assessed sation of Omran’s model to low-income and for individual included studies, while meta-analysis will be middle-income countries (LMICs) is not used to estimate study outcomes prevalence according to applicable due to the increased incidence of subgroups. Sensitivity analysis will also be performed to chronic diseases, an ageing population with further test the robustness of the findings. related health conditions and a resurgence of 1Public Health Medicine, Ethics and dissemination This proposed study does not infectious diseases among this population.2 3 University of KwaZulu-Natal require ethical approval. The results will be published as a Frenk et al3 envisioned the protracted epide- College of Health Sciences, scientific article in a peer-reviewed journal, and presented miological transition model as being able Durban, KwaZulu-Natal, South at conferences and to relevant health agencies. Africa to describe the health inequality, morbidity Trial registration number PROSPERO registration 2School of Nursing and Public and mortality by social class, this being number (CRD42016045727). Health, UKZN, Durban, KwaZulu- applicable to LMICs that are faced with Natal, South Africa prolonged periods of both infectious and 4 Correspondence to INTRODUCTION/RATIONALE chronic diseases. Sub-Saharan Africa (SSA) Olamide O Todowede; lamide. The epidemiological transition model devel- is also undergoing a demographic transition, ayodele@ gmail. com oped by Omran argued that infectious and with increased population size and growth, Todowede OO, Sartorius B. BMJ Open 2017;7:e016602. doi:10.1136/bmjopen-2017-016602 1 Open Access BMJ Open: first published as 10.1136/bmjopen-2017-016602 on 9 July 2017. Downloaded from changing age structures, inequality, urbanisation and persons, with an estimated prevalence of between 4.7% rural exodus.5 In addition, these countries now have and 54.4% in high-income countries and 8.7%–45.9% in the highest prevalence of HIV/AIDS, with many people LMICs.34 These trio conditions have emerged as one of being on antiretroviral treatment.6 Within this context, the contributors to non-AIDS-related causes of morbidity the prevalence of non-communicable diseases (trio) is and mortality globally.35 The causative and predisposing increasing and is projected to exceed that of commu- factors of developing these conditions are similar among nicable diseases by 2030,7 due to epidemiological and all populations, regardless of HIV status, and include demographic transitions.8 sociodemographic change, an aged population, globali- The leading non-communicable conditions are cardio- sation, overweight, obesity and sedentary lifestyles.16 36 37 vascular diseases (CVD) and diabetes, with hypertension Globally, non-communicable disease (NCD) comor- being a major risk factor.8 Diabetes is a metabolic condition bidities in people living with HIV (PLHIV) is high, and that affects mainly adults around the world, specifically while its prevalence is similar to the general population type 2, which is the most prevalent, accounting for approx- that is not infected, those who are infected also have to imately 95% of all cases.9 10 Diabetes and hypertension are contend with the dual burden of NCD and other infec- also major causes of increased morbidity, mortality and tious diseases.38 other health complications globally.11 12 The global prev- Studies have shown that metabolic conditions are more alence of hypertension is 20%–50%,13 while estimates common among PLHIV due to the HIV infection itself suggest that diabetes will affect approximately 642 million and the ARV regimen; however, these have been done people by 2040, mostly among adults of age 20 years and mainly in developed countries.39–41 Empirical evidence above.13–16 Patients with diabetes have an increased inci- about the differential cardiometabolic traits between dence of hypertension and other health risks,10 17 the people infected and uninfected with HIV is limited and predisposing risk factors being obesity, high carbohy- conflicting, especially for SSA, and a consolidated esti- drate and sugar diets, physical inactivity and other related mate will assist in assessing the need for monitoring factors clustering into metabolic dysfunctions.18 19 and managing metabolic dysfunction in HIV-infected Metabolic syndrome (Mets) is the clustering of risk populations.42 A narrative systematic review indicated factors for the development of type 2 diabetes and CVD,20 the difference in the prevalence of hypertension among which has an increasing prevalence in SSA.21 22 This HIV-positive populations in developed countries to be condition and its risk factor represents clinical concept between 4.7% and 54.4%, and ranging between 8.7% and used to indicate pre-diabetes and prehypertension.23 Mets 45.9% in LMICs.34 However, most of the studies included develops from clustering conditions and the risk factors in the review were from developed countries, the focus of diabetes, hypertension and CVDs. The relationship being on PLHIV, with no comparative HIV-negative between Mets, diabetes and hypertension is complex, as control groups. A review without a meta-analysis on the http://bmjopen.bmj.com/ high glucose intolerance and blood pressure are criteria prevalence of Mets among PLHIV reported a 30% mean for Mets diagnosis, while diabetes and hypertension are prevalence in Africa.43 With only a few studies being from discretely health conditions. Nevertheless, there are a South America, Africa and Asia, the result could be an variety of definitions for Mets, each with criteria that influ- overestimation or underestimation. ence its diagnosis and complexity.9 24 The influence of fat Most reviews with or without meta-analysis that have redistribution, such as visceral obesity, increased waist:hip explored the prevalence of diabetes, hypertension and/ ratio and adipose tissue, is an established presentation of or Mets have focused on PLHIV, without a comparable 25 42 44–47 cardiometabolic traits. Obesity is a major contributor to HIV-negative baseline. Moreover, data comparing on September 24, 2021 by guest. Protected copyright. increased glucose intolerance, high blood pressure
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