Prevalence of cardiometabolic diseases among ART ‐naïve people with HIV : A global systematic review and meta‐analysis

Abstract Introduction The burden of cardiometabolic diseases (CMDs) is rising in people with HIV (PWH). While extensive data exist on CMD prevalence in PWH receiving antiretroviral therapy (ART), comprehensive data on ART‐naïve PWH are scarce. We aimed to estimate the global prevalence of hypertension, diabetes, obesity and dyslipidaemia among ART‐naïve PWH and compare estimates with those on ART and HIV‐negative populations. Methods This systematic review and meta‐analysis included a search of PubMed‐MEDLINE, CINAHL, SCOPUS, Academic Search Premier, Africa‐Wide Information and Africa‐Journals Online for original articles published up to June 2024. Cross‐sectional, cohort and case‐control studies providing baseline data on CMD prevalence were included. Studies had to include ART‐naïve PWH aged ≥15 years. Two independent reviewers conducted studies screening, data extraction and methodological quality assessment. A random‐effects meta‐analysis with double arc‐sine transformation was used for prevalence estimates. The study was registered with PROSPERO (CRD42021226001). Results We included 184 studies published between 2000 and 2024, involving a total of 424 629 participants. The global pooled prevalence among ART‐naïve PWH was 14.2% (95% CI: 12.4–16.1) for hypertension, 3.6% (2.9–4.3) for diabetes, 11.5% (10.3–12.9) for body mass index‐based obesity, 18.3% (12.7–24.6) for waist circumference‐based obesity, 14.8% (12.1–17.8) for elevated total cholesterol, 17.6% (11.3–24.8) for elevated low‐density lipoprotein cholesterol, 22.9% (19.3–26.7) for elevated triglycerides and 54.6% (48.2–61.0) for low high‐density lipoprotein cholesterol, all with high heterogeneity. Significant regional variations in the prevalence of diabetes, obesity and dyslipidaemia were observed according to UNAIDS regions. Discussion We found a notable prevalence of CMDs in ART‐naïve PWH, with significant regional variations in the prevalence of diabetes, obesity and dyslipidaemia. This highlights the need for targeted interventions and early screening to address the growing CMD burden among PWH. Conclusion ART‐naïve PWH face a considerable CMD burden, emphasizing the importance of early detection and management. Regional differences in CMD prevalence call for tailored public health strategies and integration of CMD prevention into HIV care protocols.