Older Haitians Living With HIV Face a Rising Tide of Chronic Disease

In the northern hills of Haiti, where antiretroviral therapy has quietly transformed HIV from a death sentence into a manageable chronic condition, a new threat is emerging in the same clinic rooms. People who once feared the virus are now confronting hypertension, diabetes, and kidney disease—conditions that arrive not with dramatic acute illness but with the slow, cumulative weight of aging bodies. A retrospective cohort study published in PLOS Global Public Health has now quantified this shift among older adults living with HIV in northern Haiti, offering some of the most detailed data yet on how non-communicable diseases (NCDs) are reshaping the health landscape of this Caribbean nation’s HIV population.

The research team, led by Ronald Thiersaint and colleagues, focused on people living with HIV aged 40 years and older who receive care at two hospitals in northern Haiti. Their approach was deliberately pragmatic: rather than launching a new prospective study in a resource-constrained setting, the investigators mined electronic medical records from routine HIV clinical visits conducted between July 1 and September 30, 2015. This retrospective cohort design allowed them to compare the prevalence of NCDs at the moment patients initiated antiretroviral therapy (ART) with their condition after at least twelve months of follow-up on treatment. The comparison is clinically meaningful, because it captures how the metabolic and cardiovascular profile of a patient evolves once the virus is suppressed and the body endures the combined stresses of aging, chronic inflammation, medication exposure, and shifting lifestyle patterns.

The headline finding is stark. Among the 318 participants included in the analysis, 65.7 percent already had at least one non-communicable disease at the time they started ART. After a year or more on treatment, that figure climbed to 70.8 percent. In other words, roughly seven in ten older Haitians living with HIV in this cohort were carrying a chronic condition alongside their viral infection—and the burden was growing, not shrinking, as treatment succeeded. For a health system built around vertical HIV programs, where clinics, staffing, and drug supply chains are organized around a single disease, this statistic represents a structural challenge as much as a clinical one.

Beneath the aggregate numbers, the disease-specific trends tell a more nuanced story. Hypertension was the dominant condition, rising from 37.1 percent of patients at ART initiation to 47.2 percent after at least twelve months of follow-up—nearly half the cohort. Diabetes prevalence increased from 7.9 percent to 12.6 percent, a relative jump of more than half. Overweight and obesity, by contrast, remained comparatively stable, edging from 14.5 percent to 15.7 percent. The most surprising trend, however, ran in the opposite direction: renal insufficiency, which affected 31.1 percent of patients at treatment start, fell to 22.6 percent after a year on therapy. The authors suggest this decline likely reflects the clinical dynamics of ART initiation itself, since kidney function is often assessed and managed intensively around the start of treatment, and some early abnormalities may resolve as patients stabilize.

The methodological backbone of the study is its adjusted analysis, in which the researchers used statistical modeling to isolate which baseline characteristics independently predicted the development of new NCDs during follow-up. This step matters because simple associations can be misleading: a factor that appears linked to incident disease may simply be correlated with age, treatment duration, or another confounder. After adjustment, one variable stood alone. Female sex was the sole independent predictor of developing at least one new non-communicable disease, with an adjusted odds ratio of 3.29 and a 95 percent confidence interval spanning 1.40 to 7.72. Women in the cohort, in other words, were more than three times as likely as men to acquire a new chronic condition during the observation period—a disparity that demands explanation and, more urgently, a clinical response.

The secondary analysis sharpened that concern. When the team looked specifically at predictors of incident renal insufficiency—newly impaired kidney function emerging during follow-up—two factors emerged as significant. Female sex carried an adjusted odds ratio of 5.88 (95 percent CI: 1.78–19.50), meaning women faced nearly six times the odds of developing kidney impairment compared with men. Elevated systolic blood pressure also predicted incident renal insufficiency, with an adjusted odds ratio of 1.052 per unit increase (95 percent CI: 1.005–1.101). The narrow confidence interval on the blood pressure effect reflects the continuous nature of the variable: each incremental rise in systolic pressure compounds risk gradually but reliably. Together, these findings paint a picture in which older women living with HIV in northern Haiti sit at the intersection of multiple vulnerabilities—hormonal, vascular, and socioeconomic—that converge on the kidneys and the cardiovascular system.

Why should female sex carry such weight in this population? The study’s design cannot fully answer that question, but the biological and social context offers plausible threads. Women living with HIV who survive into middle age on ART experience the metabolic shifts of menopause layered over chronic immune activation from the virus itself, a combination increasingly recognized in global HIV research as a driver of hypertension and renal disease. In Haiti, gendered patterns of poverty, caregiving burden, and healthcare access may further shape exposure to risk factors and the timeliness of detection. The authors are careful not to overinterpret, but their data make one thing unambiguous: any integrated care model built for this population must attend specifically to older women, who appear to bear the highest risk of developing new chronic disease.

The public health implications extend well beyond the two hospitals studied. Haiti’s HIV program, like many across sub-Saharan Africa and the Caribbean, achieved its remarkable success by concentrating resources on a single pathogen—testing, treating, and suppressing the virus with vertical infrastructure. That infrastructure now finds itself caring for a population that is aging on treatment, and the epidemiology is shifting accordingly. When nearly two-thirds of patients arrive at ART initiation already carrying an NCD, and three-quarters carry one within a year, the clinic that measures only CD4 counts and viral loads is missing most of the clinical action. Blood pressure cuffs, glucose meters, and creatinine assays are no longer optional adjuncts to HIV care; they are core equipment.

The study also demonstrates the value of electronic medical records as an epidemiological instrument in resource-limited settings. By extracting and analyzing routine clinical data, the researchers produced actionable estimates without the cost and logistics of a dedicated prospective cohort. The trade-offs are real—retrospective designs depend on what was recorded, the observation window was confined to a 2015 data period, and the cohort of 318 patients, while substantial, limits precision in subgroup analyses, as the wide confidence intervals around some estimates attest. Yet the approach offers a replicable template: health systems in similar settings can interrogate their own records to map their NCD burden and target interventions where the adjusted risk is highest.

What emerges from northern Haiti is a portrait of success breeding a new challenge. Antiretroviral therapy has given people with HIV the years in which chronic diseases take root, and those years are now filling with hypertension, diabetes, and kidney disease. The study’s authors frame their findings as a call for integrated care models—clinical systems that treat the whole aging patient rather than a single infection—and their data identify precisely where that integration should begin: with older women, whose odds of developing new NCDs and renal insufficiency dwarf those of their male counterparts. As HIV programs worldwide confront the same demographic transition, the experience of this Haitian cohort offers both a warning and a starting point for the next chapter of the epidemic’s response.

Subject of Research: Non-communicable disease burden among older adults living with HIV on antiretroviral therapy in northern Haiti

Article Title: Prevalence and incidence of non-communicable diseases among older adults living with HIV on antiretroviral therapy in Northern Haiti: A retrospective cohort study

Article References: Thiersaint, R., Mésidor, R. N., Pelletier, V., Norcéide, C. P., Dubé, J. G., Prévil, H., François, K., Koama, J. B. T., Melchior, M. A., & Charles, M. (2026). Prevalence and incidence of non-communicable diseases among older adults living with HIV on antiretroviral therapy in Northern Haiti: A retrospective cohort study. PLOS Global Public Health, 6(10), e0007175. https://doi.org/10.1371/journal.pgph.0007175

Image Credits: AI Generated

DOI: 10.1371/journal.pgph.0007175

Keywords: HIV, antiretroviral therapy, non-communicable diseases, hypertension, diabetes, renal insufficiency, Haiti, older adults, women's health, retrospective cohort, integrated care, global public health