The Study was conducted in health institution of Gamo-Gofa zone which is located about 505 km south west from Addis Ababa. A zone has a population of 1,960,417 and of this 960,604 was males and 999,813 were females. It has 15 districts and two town administration. With this there are three hospitals and 73 health centres (including upgrading health centres) offering health care services for the population. All three hospitals and 14 health centre offer HIV chronic care services There are 8933 of people living with HIV/AIDS who have follow up at health institution of the Gamo-Gofa zone, among them 3985 are on HAART and 4948 are on Pre ART.

Retrospective cohort study design was implemented from January 2015 to May 2016.

All HIV infected adult patients’ age ≥ 18, who has followed up at health institution of Gamo Gofa zone and HIV infected adult patients age ≥ 18, who has follow up at selected health institution of Gamo Gofa zone were source and study population respectively. Furthermore All HIV patients on HAART and Pre- HAART, who have completed charts was included in the study.

Sample size was calculated for first specific objective by using proportion of hypertension from Addis Ababa (31.5%) and Gondar hospital (28.3%), considering Z-score corresponding to 95% CI, 5% degree of precision, design effect of two and ten percent non response rate; it gives 728 and 686 respectively. The sample size was determined for Predictors also by using StatCalc program of Epi-Info version 7 with considering the following assumptions; confidence level of 95%, power of 80%, exposed to non-exposed ratio 3:1, design effect of 2, fifteen percent lost to follow up, Odds ratio and its proportion obtained from previous Literature.

Based on the sample size calculated above, sample size for triglyceride was 380 which was large, so considering design effect and lost to follow up, 874 (582 ART and 292 patients on Pre-ART) will be selected (Table 1).

Two hospitals (Sawula and Arba Minch hospital) and four health center (Sawula health, Birbir, and Arba Minch health center) was selected by simple random sampling. Proportional to size allocation of sample was distributed to health institution. After random allocation, randomly generated number was used to pick out card number of an individual on Pre-ART and HAART, and then all information was accessed from the card and patients through measurements and face to face interview (Table 2).

1) Dependent variables: Incidence of systemic hypertension

2) Independent variables

Socio-economic and demographic variables (Ethnicity, Income, education, household indicators, occupation, age, sex, and residences), Life style and behavioral variables (tobacco and alcohol use, physical inactivity, intake of fruit and vegetables), Biochemical test variables (Measured weight, height, waist, Timed walk, and pedometer) and Medical history and HIV related variables (Family history of HPN, stage of RVI, Duration on HAART, type of treatment received, family history of DM, history of UTI) were used to collect and analyze data.

The data was collected by ART nurses, who were trained; in the respective health institution after consent from each respondent is obtained through interview- based, pre-coded and pretested structured questionnaire which was adapted from the WHO STEPS instrument [17]. This instrument was used to collect data

on selected socio-demographic characteristics, lifestyle and behavioural characteristics including, physical activity, physical Measurements of weight, height, waist and hip circumference, and Blood glucose, as well as blood pressure.

Weight and height were measured with participants standing without shoes and wearing light clothing. Participants stood upright with the head in Frankfort plane for height measurement. Height was recorded to the nearest 0.5 cm, and weight was recorded to the nearest 100 g. Body-mass index (BMI) was calculated as weight in kilograms over height in meters squared [weight (kg)/(height (m))²].

The global physical activity questionnaire (GPAQ) section of the STEPS instrument was used for assessment of physical activity, and total physical activity was presented in MET (metabolic equivalent) minutes per week. The instrument looks into three major domains of day-to-day activities; work (including domestic work), transport, and recreational activities. Level of total physical activity was subsequently classified into high, moderate, or low using the GPAQ analysis guideline provided along with the STEPS instrument. Blood pressure was measured in a sitting position using a digital device (Omron M4-I^®) after the study participant rested for at least five minutes. Three consecutive measurements were made in an interval of at least 3 minutes. Self-reported health status was determined by asking the participant.

Pre-test was conducted to identify a potential problem that was aroused during the actual data collection period. Trained ART nurses were used to collect the data after thoroughly explaining the objective of the study to each study subject and informed consent was obtained. There were also regular supervision and timely check-up of the completeness and consistency of responses to questions throughout the data collection period.

Exposed: HIV patients who enrolled for chronic care and started HAART.

None exposed: HIV patients who enrolled for chronic care and not yet started HAART.

Outcome: an individual with sustained high blood pressure (SBP ≥ 140 or DBP ≥ 90 mmHg) [18] or reported regular use of anti-hypertensive medication after ART follow up (s).

Hypertension: was defined as a sustained high blood pressure (SBP ≥ 140 or DBP ≥ 90 mmHg) [18] or reported regular use of anti-hypertensive medication after ART follow up (s).

Body mass index (BMI): a measure of overall adiposity, will be categorized according to WHO criteria (underweight: BMI < 18.5 kg/m²; normal: 18.5 - 24.9 kg/m²; overweight: 25.0 - 29.9 kg/m²; and obese: BMI ≥ 30.0 kg/m²).

Alcohol consumption: it will be classified as low (<1 alcoholic beverage a week), moderate (1 - 21 alcoholic beverages a week), and high to excessive consumption (>21 alcoholic beverages a week) according to WHO classification.

The data was cleaned to check for its completeness, consistency and the presence of missed values and variables. Any error identified was corrected as necessary. Then, it was entered into a pre-designed format in Epi-Info version 7 and transferred to SPSS version 21 for analysis. An assumption to apply binary logistic regression including fitness of model was assessed. Descriptive statistics were done using frequencies, percentages, mean, median, standard deviation and other summary statistics.

Binary Logistic regression Model was fitted first by Bivariable analysis between each independent variable and the dependent one. Independent variables with a p-value < 0.2 was then included in the multivariate analysis. Those predictors with p-value < 0.05, in the multivariate analysis, was considered as independent and significant predictors for incidences of hypertension and was included in the final model. Crude and adjusted odds ratio with 95% confidence interval was also be reported.

Ethical clearance was obtained from Institutional Review office of Arba Minch University, college of medicine and Health Science. Permission letter was also obtained from Gamo-Gofa zone health departments and the departments also let respective hospitals and health centers to provide favorable media to conduct the study. Anonymity was maintained during abstraction of the data from the charts and informed verbal consents were taken from the respondents. Patients with hypertension and DM were informed about the status and refer to chronic hypertension and DM care follow up.

A total of 834 HIV/AIDS infected (95.4% response rate) were included in this study. The mean age was 35.4 ± 8.15 years. More than half of them were Orthodox Christians (64.7%) and married (56.7%). More than three fourth (83.3%) of them were from urban area and twenty three point four percent (195) were Housewife and about one third (42.0%) were Gamo ethnicity (Table 3).

Fifty one participants (6.1%) declared that they were smoking cigarettes previously. Concerning their alcohol use, 161 (19.3%) were ever users. Eight seven (10.1%) was involved in vigorous activities such as carrying or lifting heavy loads, and construction works. Most participants (97.4%) use to walk for at least 10 minutes continuously every day.

More than three fourth (83.9%) of respondents reported that they usually use vegetables at least 1 - 3 days in a week. Forty eight of the respondents (5.8%) do not eat fruits at all in any days of a week. Only five of (0.5%) respondents have reported use of hard drug like hashish and cocaine.

Five hundred fifty (65.9%) of PLHIV patient enrolled for HAART treatment and twenty one point one percent (176) were on 1a (30). Two percent (17) of PLHIV were known diabetic patient and more than three fourth (84.5%) of the patients have no history of hypertensions. Nearly half of (47.7%) of respondents has been started ART at WHO clinical stage and one third of the started at CD4 count of less than 200 (Table 4).

The mean systolic and diastolic BP results were 115.7mmHg (±16.1 SD) and 74.9 mmHg (±12.4 SD). The overall incidence of hypertension was 20% (95% CI: 19.9 - 20.03), in equal proportion in Pre-HAART (20.1%) and HAART (20.0%) receiving patients (Figure 1).

In bivariable analysis, age, sex, residence and marital status were not significantly associated with Hypertension, but all other variables like modifiable (educational status, religion, occupation, and monthly income) and non-modifiable (ethnicity) and were significantly associated with incidence of Hypertension in cohort of HIV infected patients. In Bivariable analysis, only vigorous activities were significant and all other variables, like Tobacco use, fruit consumption and Duration on ART were not significant (Table 5 and Table 6).

The study revealed modifiable; monthly income, Occupational status, marital status, Body mass index, and vigorous activities and non-modifiable Family history of hypertension were important predictors of hypertension among HIV infected patients. Other variables like educational status, religion and walking 10 minute per day were factors associated with Hypertension with consider ding the effect of other variables in multiple regression analysis, and it effect diluted in final analysis (Table 7).