Hypertension and Diabetes Dominate Among HIV Patients on Antiretroviral Therapy in Northwestern Nigeria

People living with HIV who have been taking combination antiretroviral therapy for at least six months in three Northwestern Nigerian states carry a substantial burden of non-communicable diseases, with hypertension and diabetes emerging as the leading diagnosed conditions, according to a cross-sectional study published in Discover Public Health. The research, conducted between January and June 2025 across Kebbi, Sokoto and Zamfara States, surveyed 246 adults receiving highly active antiretroviral therapy, commonly known as HAART, and combined structured interviewer-administered questionnaires with reviews of medical records to verify diagnoses. The findings arrive at a moment when the long-term success of antiretroviral treatment has fundamentally reshaped the health profile of HIV-positive populations, transforming what was once a rapidly fatal infection into a manageable chronic condition and exposing patients, over decades of life, to the same chronic disease risks that confront the general population.

The scale of the challenge is considerable. Non-communicable diseases, a broad category that includes cardiovascular diseases, diabetes, chronic respiratory illnesses, cancers and mental health disorders, account for roughly 71 percent of all deaths worldwide, and nearly three-quarters of those deaths occur in low- and middle-income countries. Sub-Saharan Africa sits at the center of an epidemiological transition often described as a double burden of disease, in which chronic, lifestyle-related conditions rise in parallel with persistent infectious disease threats. The HIV epidemic has been a central driver of this transition, because the region is home to the majority of the world’s people living with HIV. As antiretroviral therapy extends survival, patients accumulate years of exposure to both conventional risk factors, such as tobacco use and poor diet, and HIV-specific mechanisms, including chronic inflammation, immune dysregulation and the metabolic side effects of the drugs themselves.

In Nigeria, an estimated 1.9 million people are living with HIV, with prevalence varying across regions. The three states examined in this study face particular structural challenges. Kebbi State, with a population estimated at more than 4.2 million, reports an HIV prevalence of 0.6 percent; Sokoto State, home to approximately 6.3 million people, reports 0.4 percent; and Zamfara State, with an estimated 5.8 million residents, also reports 0.4 percent. Limited healthcare infrastructure, poverty and insecurity compound the burden of both HIV and chronic disease in the region, and comprehensive data on non-communicable disease prevalence among HIV-positive patients there had remained scarce. The study was designed to fill that gap by measuring how frequently diagnosed non-communicable diseases occur among patients on treatment and by identifying the social, behavioral and treatment-related factors associated with their development.

The methodology reflected the constraints and realities of research in resource-limited settings. Using a multi-stage sampling approach, the investigators purposively selected the three states, then applied stratified random sampling to secondary and tertiary healthcare facilities and recruited available clinic attendees. The sample size was calculated with Cochran’s formula, assuming a prevalence of 17.7 percent drawn from previous research in North Central Nigeria, a 95 percent confidence level and a 5 percent margin of error, yielding a base estimate of 224 participants. After adding 10 percent to allow for non-response, the final target was 246 participants, distributed evenly at 82 per state. Eligible participants were adults aged 18 or older who had received HAART for at least six months and had complete medical records; those with incomplete records or shorter treatment durations were excluded. Ethical approval came from the health research ethics committees of the three state ministries of health, and written informed consent was obtained from every participant. The questionnaire instrument, covering socio-demographics, HIV and treatment history, lifestyle factors, screening history and health perceptions, was validated by experts and achieved a Cronbach’s alpha of 0.7026, indicating acceptable internal consistency.

The demographic profile of the cohort reflected a population in its productive years navigating a chronic illness. The mean age was 37.0 years with a standard deviation of 9.5, and the largest single age group, 45.9 percent of participants, fell between 35 and 41 years. Men made up 61.4 percent of respondents, a predominance the authors note contrasts with national HIV epidemiological patterns and may relate to gender differences in healthcare utilization and delayed health-seeking behavior among men in sub-Saharan Africa. Most participants were married, 62.6 percent; had tertiary education, 63.8 percent; and were employed, 52.4 percent. Across the three states, the majority of respondents reported no diagnosed non-communicable disease: 67.1 percent in Kebbi, 79.3 percent in Sokoto and 72.0 percent in Zamfara, amounting to 73.5 percent overall.

Among those with diagnosed conditions, hypertension dominated in every state. It affected 19.5 percent of participants in Kebbi, 17.1 percent in Zamfara and 11.0 percent in Sokoto. Diabetes was the second most common diagnosis, ranging from 4.9 percent in Sokoto to 9.8 percent in Kebbi. The co-occurrence of hypertension and diabetes, a clustering of cardiovascular risk factors with serious implications for stroke and heart disease, was observed in 2.4 to 3.7 percent of respondents. Cardiovascular disease itself was reported by only 1.2 percent of participants in each state, a figure the authors attribute more plausibly to diagnostic limitations than to a genuine absence of disease, since cardiovascular conditions are frequently under-recognized in HIV care settings in low- and middle-income countries where access to diagnostic tools and specialist care is constrained. Similarly, the finding that nearly three-quarters of participants had no diagnosed non-communicable disease may, the authors suggest, reflect underdiagnosis driven by limited screening access and inadequate service integration rather than true low prevalence.

The statistical analysis identified several factors significantly associated with having a diagnosed non-communicable disease. Age showed a strong association, with prevalence rising markedly after age 42 and every participant aged 56 or older having received a diagnosis. Marital status mattered as well, with widowed individuals carrying the highest proportion of diagnoses at 71.4 percent, compared with 27.9 percent among married and 24.0 percent among divorced respondents, a pattern the authors link to social isolation, psychological stress and reduced economic support. Educational level was significant, with secondary-educated respondents showing the highest prevalence at 38.7 percent, and occupation was significant too, with the self-employed at 44.9 percent and the unemployed at 37.8 percent showing the greatest burdens, patterns attributed to economic instability and limited healthcare access. Gender, by contrast, was not significantly associated with disease: although men had more diagnosed cases, 30.5 percent versus 22.1 percent among women, the difference did not reach statistical significance.

Behavioral and treatment-related factors produced some of the study’s most striking results. Smoking was strongly associated with non-communicable disease, with 84.6 percent of smokers carrying a diagnosis compared with 24.0 percent of non-smokers, consistent with extensive evidence that tobacco use accelerates cardiovascular and metabolic complications among people living with HIV by exacerbating immune activation and contributing to endothelial dysfunction. Alcohol consumption, physical activity level and dietary patterns showed no significant associations in this dataset, which the authors caution may reflect self-reporting bias or limitations in the measurement tools rather than genuine irrelevance. Receiving health advice was significantly associated with diagnosis, with 47.9 percent of those who had received counseling carrying a condition versus 8.5 percent of those who had not, but the authors interpret this as likely reverse causation: people diagnosed with disease are more likely to be counseled, not the other way around. The HAART regimen itself was significantly associated with disease prevalence. Most diagnosed cases occurred among patients on first-line regimens, with hypertension at 18.7 percent and diabetes at 5.9 percent in that group, while among those on second-line therapy, 22.2 percent had diabetes and 22.2 percent had both hypertension and diabetes. The authors note that the predominance of cases on first-line regimens may simply reflect the larger share of patients on those regimens, but they emphasize that certain antiretroviral drugs are known to contribute to insulin resistance, dyslipidemia and altered fat distribution, all of which elevate long-term diabetes and cardiovascular risk. They also flag that a proportion of respondents were unaware of their own treatment regimen, pointing to gaps in patient education.

The study’s authors argue that the findings make the case for integrated HIV and non-communicable disease care models in Nigeria, an approach the World Health Organization recommends for improving early detection and reducing morbidity and mortality. Their recommendations include routine blood pressure, glucose and lipid profile screening within HIV care under the National AIDS and STI Control Programme; tailored health education targeting patients with lower educational attainment; age- and gender-sensitive interventions focused on middle-aged adults; socio-economic support such as community health insurance for unemployed and self-employed patients; and strengthened surveillance through improved electronic medical records. As a cross-sectional study relying partly on self-report and facility-based sampling, the research captures associations rather than causal effects and represents patients engaged in care at surveyed facilities.

Subject of Research: Prevalence of non-communicable diseases among people living with HIV on antiretroviral therapy in Northwestern Nigeria

Article Title: Assessment of non-communicable diseases prevalence among people living with HIV on HAART in Northwestern Nigeria: a cross-sectional study

Article References: Iorhen, N. A., Ahmad, U. A., Ikechukwu, S. M., Edionwele, I., Ahen, D. D., Takwi, S. P., Lan, T., & Popoola, D. (2026). Assessment of non-communicable diseases prevalence among people living with HIV on HAART in Northwestern Nigeria: a cross-sectional study. Discover Public Health, 23(1), Article 1725. https://doi.org/10.1186/s12982-026-02798-x

Image Credits: AI Generated

DOI: 10.1186/s12982-026-02798-x

Keywords: HIV, HAART, non-communicable diseases, hypertension, diabetes, Nigeria, cross-sectional study, smoking, antiretroviral therapy, comorbidity, public health, integrated care