Cardiovascular risk factors in adult Malawians on long-term antiretroviral therapy

Trans R Soc Trop Med Hyg. 2011 Nov;105(11):644-9. doi: 10.1016/j.trstmh.2011.07.016. Epub 2011 Sep 15.


Around 225,000 patients currently receive antiretroviral therapy (ART) in the Malawi scale-up programme that uses the public health approach to ART. There are concerns that cardiovascular disease risk factors are common in ART patients, but few data exist from sub-Saharan Africa, and none from Malawi. We did a cross-sectional study of cardiovascular risk factors in urban, adult, Malawian ART patients, with the WHO STEP-wise surveillance tool. We enrolled 174 long-term (>1 year) ART patients during routine clinic visits, mean age 40.8 years (range 18-69), 61.5% female, 97.1% on first-line regimens, median duration ART 35.5 months. Insufficient fruit and vegetable diet (67.6%), raised blood pressure (45.9%), increased waist-hip ratio (45.4%), raised total cholesterol levels (31.0%) and low physical activity level (27.0%) were common, while current smoking (0.6%), current alcohol consumption (2.3%) and elevated glucose levels (1.2%) were rare. In multivariable analyses, higher age was associated with low physical activity, raised blood pressure, being overweight, and increased waist-hip ratio. Longer duration of ART was not associated with any risk factor and was protective for being overweight. Cardiovascular risk factors were common among long-term ART patients in Malawi. This requires more attention and further study in programmes using the public health approach to ART.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Anti-HIV Agents / administration & dosage*
  • Atherosclerosis / complications
  • Atherosclerosis / epidemiology*
  • Atherosclerosis / etiology*
  • Cross-Sectional Studies
  • Feeding Behavior
  • Female
  • HIV Infections / complications
  • HIV Infections / drug therapy*
  • HIV Infections / epidemiology*
  • Humans
  • Hypercholesterolemia / complications
  • Hypercholesterolemia / epidemiology
  • Hypertension / complications
  • Hypertension / epidemiology
  • Malawi / epidemiology
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Overweight / complications
  • Overweight / epidemiology
  • Risk Factors
  • Sedentary Behavior
  • Urban Health
  • Urban Population / statistics & numerical data
  • Waist-Hip Ratio


  • Anti-HIV Agents