Interactions between long-term Antiretroviral Therapy and Risk of Hypertension among People Living with HIV in an Urban HIV Clinic in Cameroon, 2024: A Case-control Study

Background Survival gains under ART have shifted morbidity among PLHIV toward non-communicable diseases, with HTN emerging in sub-Saharan Africa. In Cameroon, evidence from routine HIV care is limited and integration of HTN services is uneven. We aimed to identify factors associated with HTN among PLHIV in Yaounde to inform standardized HTN care within HIV services. Methods We conducted a case-control study at the Central Hospital of Yaoundé (n = 460; 199 HTN cases, 261 controls). Cases were defined as SBP/DBP ≥ 140/90 mmHg or current antihypertensive therapy; controls had BP < 140/90 mmHg without therapy. We collected sociodemographic, clinical, antiretroviral therapy (ART), viral-load, and lifestyle data. Group differences used standard statistical tests. Multivariable logistic regression and adjusted a priori for age, sex, BMI, ART duration, HIV stage at initiation, viral-load class, and lifestyle factors estimated adjusted odds ratios (aOR, 95% CI). Collinearity was assessed via GVIF (cutoff = 5) and model discrimination by ROC/AUC. Two-sided p < 0.05 denoted significance; reporting followed STROBE. Results Among 460 PLHIV, hypertensive cases were older (≥ 40 y: 92.5% vs 78.5%; p < 0.001) and more often obese (27.6% vs 19.5%; p = 0.024). Family history of HTN was more frequent in cases (p < 0.001), and employment differed (unemployed/retired more common among cases; p = 0.037). Sex, marital status, education, HIV stage at initiation, treatment line, and recent viral-load class were not associated (all p > 0.05). In adjusted models, age < 40 y was inversely associated with HTN (aOR 0.37; 95% CI 0.19–0.69; p = 0.002), while obesity increased odds (aOR 1.96; 95% CI 1.18–3.28; p = 0.010). Longer ART exposure (≥ 15 y) showed borderline evidence (aOR 1.50; 95% CI 0.99–2.30; p = 0.059). No dietary variable retained significance; lower odds across some fruit/vegetable frequencies versus the biweekly reference likely reflect measurement or residual confounding. Diagnostics indicated no concerning multicollinearity (all GVIF < 5) and moderate discrimination (AUC 0.689). Conclusions In routine HIV care in Yaoundé, HTN clustered with aging and adiposity, while the apparent effect of long ART exposure attenuated after adjustment. Findings support embedding standardized HTN screening and management and including weight management and lifestyle counseling within HIV services (WHO HEARTS) and encourage prospective studies to test integrated models and clarify causal pathways.