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Ello FN, Soya EK, Kassi NA, Coffie PA, Koaukou GA, Mossou MC, Adama D, Coulibaly I, Ehui E, Tanon A, Eholie SP. Prevalence of severe cardiovascular abnormalities amongst West African HIV-infected patients on antiretroviral therapy followed at a referral HIV centre. S Afr J Infect Dis 2021; 36:187. [PMID: 34485487 PMCID: PMC8378198 DOI: 10.4102/sajid.v36i1.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 11/26/2020] [Indexed: 11/28/2022] Open
Abstract
Background With success and effective long-term antiretroviral treatment (ART), HIV-infected patients live longer and frequently developed non-communicable diseases (NCDs). Few studies have been conducted in low-income countries, particularly in West Africa. Methods We carried out a cross-sectional study in the referral HIV centre of the Service des Maladies Infectieuses et Tropicales (SMIT) in Abidjan. From April to September 2015, we consecutively included HIV-1 infected patients aged 18 years and older, and on ART for a minimum of 12 months. Data were collected using a structured questionnaire, and entered into the centre’s computerised HIV database. Clinical assessment, laboratory tests, electrocardiogram, transthoracic echocardiography and vascular Doppler ultrasound were performed. The main outcome was the prevalence of patients with severe cardiovascular abnormalities (SCA). Univariate and multivariate logistic regressions were used to identify factors associated with SCA. Results Out of 278 patients (median age 46 years, interquartile range [IQR: 41–52]), 74.5% were female. Overall, the median duration of ART was 84 months (IQR: 54–126). One hundred and ninety-nine (71.6%) patients were on first-line ART regimen and 229 (82.4%) were virologically suppressed with a median CD4 count of 511 cells/mm3 (IQR: 347–529). Basically, cardiovascular abnormalities were mainly non-obstructive carotid plaques (19.1%) followed with left ventricular diastolic dysfunction (16.5%). The overall prevalence of SCA in the study population was 7.6% (95% Confidence Interval [95% CI]: 4.7–11.3). The prevalence of SCA 7.6% (95% Confidence Interval [95% CI]: 4.7–11.3). In multivariate analysis, age > 50 years and nadir CD4 count > 200 cells/mm3 were significant predictors of SCA. Conclusion The prevalence of SCA is high in West African HIV-treated patients. Given the high mortality associated with cardiovascular diseases in the general population, refining disease preventive strategies in HIV-positive subjects is essential to continue prolonging their life.
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Affiliation(s)
- Frederic N Ello
- Département de Dermatologie-Infectiologie, Unité de Formation et de Recherche des Sciences Médicales, Université Felix Houphouët-Boigny, Abidjan, Côte d'Ivoire.,Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire
| | - Esaie K Soya
- Institut de Cardiologie d'Abidjan, Abidjan, Côte d'Ivoire
| | - N'douba A Kassi
- Département de Dermatologie-Infectiologie, Unité de Formation et de Recherche des Sciences Médicales, Université Felix Houphouët-Boigny, Abidjan, Côte d'Ivoire.,Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire
| | - Patrick A Coffie
- Département de Dermatologie-Infectiologie, Unité de Formation et de Recherche des Sciences Médicales, Université Felix Houphouët-Boigny, Abidjan, Côte d'Ivoire.,Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire
| | - Gisèle A Koaukou
- Département de Dermatologie-Infectiologie, Unité de Formation et de Recherche des Sciences Médicales, Université Felix Houphouët-Boigny, Abidjan, Côte d'Ivoire.,Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire
| | - Melaine C Mossou
- Département de Dermatologie-Infectiologie, Unité de Formation et de Recherche des Sciences Médicales, Université Felix Houphouët-Boigny, Abidjan, Côte d'Ivoire.,Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire
| | - Doumbia Adama
- Département de Dermatologie-Infectiologie, Unité de Formation et de Recherche des Sciences Médicales, Université Felix Houphouët-Boigny, Abidjan, Côte d'Ivoire.,Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire
| | | | - Eboi Ehui
- Département de Dermatologie-Infectiologie, Unité de Formation et de Recherche des Sciences Médicales, Université Felix Houphouët-Boigny, Abidjan, Côte d'Ivoire.,Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire
| | - Aristophane Tanon
- Département de Dermatologie-Infectiologie, Unité de Formation et de Recherche des Sciences Médicales, Université Felix Houphouët-Boigny, Abidjan, Côte d'Ivoire.,Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire
| | - Serge P Eholie
- Département de Dermatologie-Infectiologie, Unité de Formation et de Recherche des Sciences Médicales, Université Felix Houphouët-Boigny, Abidjan, Côte d'Ivoire.,Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire
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Comparison of different cardiovascular risk tools used in HIV patient cohorts in sub-Saharan Africa; do we need to include laboratory tests? PLoS One 2021; 16:e0243552. [PMID: 33507945 PMCID: PMC7842918 DOI: 10.1371/journal.pone.0243552] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 11/23/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction Cardiovascular disease (CVD) is the leading cause of death globally, representing 31% of all global deaths. HIV and long term anti-retroviral therapy (ART) are risk factors for development of CVD in populations of people living with HIV (PLHIV). CVD risk assessment tools are currently being applied to SSA populations, but there are questions about accuracy as well as implementation challenges of these tools in lower resource setting populations. We aimed to assess the level of agreement between the various cardiovascular screening tools (Data collection on Adverse effects of anti-HIV Drugs (D:A:D), Framingham risk score, WHO risk score and The Atherosclerotic Cardiovascular Disease Score) when applied to an HIV ART experienced population in Sub-Saharan Africa. Methods This study was undertaken in an Anti-Retroviral Long Term (ALT) Cohort of 1000 PLHIV in care who have been on ART for at least 10 years in urban Uganda. A systematic review was undertaken to find the most frequently used screening tools from SSA PLHIV populations; these were applied to the ALT cohort. Levels of agreement between the resulting scores (those including lipids and non-lipids based, as well as HIV-specific and non-HIV specific) as applied to our cohort were compared. Prevalence Bias Adjusted Kappa was used to evaluate agreement between tools. Results Overall, PLHIV in ALT cohort had a median score of 1.1–1.4% risk of a CVD event over 5 years and 1.7–2.5% risk of a CVD event over 10 years. There was no statistical difference in the risk scores obtained for this population when comparing the different tools, including comparisons of those with lipids and non-lipids, and HIV specific vs non-HIV specific. Conclusion The various tools yielded similar results, but those not including lipids are more feasible to apply in our setting. Long-term cohorts of PLHIV in SSA should in future provide longitudinal data to evaluate existing CVD risk prediction tools for these populations. Inclusion of HIV and ART history factors to existing scoring systems may improve accuracy without adding the expense and technical difficulty of lipid testing.
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Aouam A, Marmouch H, Kooli I, Marrakchi W, Hellara I, Neffati F, Najjar F, Chakroun M. [Metabolic syndrome among people with HIV in central Tunisia: Prevalence and associated factors]. ANNALES PHARMACEUTIQUES FRANÇAISES 2021; 79:465-472. [PMID: 33516719 DOI: 10.1016/j.pharma.2021.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/28/2020] [Accepted: 01/15/2021] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Metabolic abnormalities are frequently reported in HIV infection. They were mainly related to the chronic infection and the use of antiretroviral therapy. OBJECTIVE Describe the epidemiological, clinical, laboratory and treatment features of people living with HIV (PLHIV) on antiretroviral therapy and determine the prevalence of metabolic syndrome and its associated factors. MATERIALS AND METHODS We conducted a cross-sectional, descriptive and analytical study in the service of Infectious Diseases of the University Hospital of Monastir. We included all PLHIV on antiretroviral therapy for at least 3 months. Biological explorations based on metabolic parameters were performed systematically for all patients after informed consent. Metabolic syndrome was assessed according to the definitions of the International Diabetes Federation (IDF) in 2005. We divided the patients into two groups: Group A: PLHIV with metabolic syndrome (n=19) and Group B: PLHIV without metabolic syndrome (n=51). RESULTS We included in this study 70 PLVIH. The metabolic syndrome was noted in 19 cases (27.1%). The average age was 43.7 years in group A and 36.7 years in group B. Gender distribution were uniform in the two groups (P=0.4). HIV infection has been evolving for 9.7 and 5.8 years respectively in group A and B, P=0.017. Body mass index (BMI) was significantly higher in group A (26.4 vs 23.5kg/m2, P=0.008). Two patients in group A (10.5%) and 14 patients in group B (27.4%) had a low CD4 count (<200/mm3). Protease inhibitor regimens were prescribed in five cases (26.3%) in group A and 26 cases (50.9%) in group B. In multivariate models, Age over 40 (OR=9.9, 95% CI 2.4-40.6, P=0.001) and BMI ≥25 Kg/m2 (OR=8.47, 95% CI 1.94-36.8, p=0.004) were both independently associated with the presence of the metabolic syndrome. CONCLUSION Metabolic syndrome is common among PLHIV on antiretroviral therapy. The identification of factors associated is a main parameter for early detection of metabolic risk and personalized management.
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Affiliation(s)
- A Aouam
- Service des Maladies Infectieuses, EPS Fattouma Bourguiba, 5019 Monastir, Tunisie.
| | - H Marmouch
- Service d'endocrinologie et de médecine interne, EPS Fattouma Bourguiba, 5019 Monastir, Tunisie.
| | - I Kooli
- Service des Maladies Infectieuses, EPS Fattouma Bourguiba, 5019 Monastir, Tunisie.
| | - W Marrakchi
- Service des Maladies Infectieuses, EPS Fattouma Bourguiba, 5019 Monastir, Tunisie.
| | - I Hellara
- Laboratoire de biochimie, EPS Fattouma Bourguiba, 5019 Monastir, Tunisie.
| | - F Neffati
- Laboratoire de biochimie, EPS Fattouma Bourguiba, 5019 Monastir, Tunisie.
| | - F Najjar
- Laboratoire de biochimie, EPS Fattouma Bourguiba, 5019 Monastir, Tunisie.
| | - M Chakroun
- Service des Maladies Infectieuses, EPS Fattouma Bourguiba, 5019 Monastir, Tunisie.
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Gebrie A. The burden of metabolic syndrome in patients living with HIV/AIDS receiving care at referral hospitals of Northwest Ethiopia: A hospital-based cross-sectional study, 2019. Diabetes Metab Syndr 2020; 14:1551-1556. [PMID: 32947754 DOI: 10.1016/j.dsx.2020.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/31/2020] [Accepted: 08/02/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION There is a growing concern about metabolic syndrome among HIV-infected patients. Therefore, this study aims to determine the burden of metabolic syndrome among patients living with HIV/AIDS at referral hospitals of Northwest Ethiopia. MATERIALS AND METHODS a hospital-based cross-sectional study was conducted at referral hospitals of Northwest Ethiopia between February 2019 and April 2019. Using the WHO stepwise approach, sociodemographic, behavioral, and clinical data were collected from 407 adult patients. Lipid profiles, fasting blood sugar, as well as anthropometric indicators, were also measured. In addition, multivariate binary logistic regression analysis was performed. RESULTS The prevalence of metabolic syndrome was found to be 24.6% (95 CI: 20.42,28.78). Multivariate logistic regression analysis revealed that age [AOR (95% CI) 1.04 (1.003,1.074), p < 0.05]; female gender [AOR (95% CI) 9.66 (4.40, 21.22), p < 0.05]; marital status, single referent, separated [AOR (95% CI) 4.77 (1.83, 12.41), p < 0.05] and widowed [AOR (95% CI) 3.868(1.375, 10.883), p < 0.05]; monthly income (<2000 Ethiopian Birr referent) > 5000 ETB [AOR (95% CI) 3.543 (1.299, 9.664), p < 0.05]; and urban residence [AOR (95% CI) 2.118 (1.089, 4.119), p < 0.05] have shown statistically significant association with odds of metabolic syndrome. CONCLUSION The burden of metabolic syndrome was notably higher. Age, gender, marital status, monthly income, residence, waist circumference, and hypertension of patients were significantly associated with metabolic syndrome.
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Affiliation(s)
- Alemu Gebrie
- Department of Biomedical Science, School of Medicine, Debre Markos University, Debre Markos, Ethiopia.
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So-Armah K, Freiberg MS. HIV and Cardiovascular Disease: Update on Clinical Events, Special Populations, and Novel Biomarkers. Curr HIV/AIDS Rep 2019; 15:233-244. [PMID: 29752699 DOI: 10.1007/s11904-018-0400-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW The objective of this review is to provide an update on the link between HIV infection and cardiovascular disease (CVD). We will focus our review mainly on literature describing clinical CVD events and understudied topics of importance. RECENT FINDINGS Heart failure, peripheral artery disease, and stroke are CVD modalities deserving more attention in the context of HIV infection in the highly active antiretroviral therapy era. Incidence data on clinical CVD from HIV populations in low- and middle-income countries are limited. Multisubstance use is common in HIV, but understudied as a moderator or mediator of the association between HIV and CVD. CVD risk assessment in HIV remains challenging, but new research into novel biomarkers may provide further insights. There is also a need for inclusion of non-biologic factors in our attempts to understand, quantify, and predict CVD risk among PLWHA. Significant attention has been paid to generating and testing hypotheses to understand the mechanisms of myocardial infarction in HIV. Similar attention is deserving for heart failure, PAD, stroke, and cardiovascular disease risk in resource-limited settings and among substance users with HIV.
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Affiliation(s)
- Kaku So-Armah
- School of Medicine, Boston University, Boston, MA, USA.
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6
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Muiru AN, Bibangambah P, Hemphill L, Sentongo R, Kim JH, Triant VA, Bangsberg DR, Tsai AC, Martin JN, Haberer JE, Boum Y, Plutzky J, Hunt PW, Okello S, Siedner MJ. Distribution and Performance of Cardiovascular Risk Scores in a Mixed Population of HIV-Infected and Community-Based HIV-Uninfected Individuals in Uganda. J Acquir Immune Defic Syndr 2018; 78:458-464. [PMID: 29652762 PMCID: PMC6019157 DOI: 10.1097/qai.0000000000001696] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND The utility and validity of cardiovascular diseases (CVD) risk scores are not well studied in sub-Saharan Africa. We compared and correlated CVD risk scores with carotid intima media thickness (c-IMT) among HIV-infected and uninfected people in Uganda. METHODS We first calculated CVD risk using the (1) Framingham laboratory-based score; (2) Framingham nonlaboratory score (FRS-BMI); (3) Reynolds risk score; (4) American College of Cardiology and American Heart Association score; and (5) the Data collection on Adverse Effects of Anti-HIV Drugs score. We then compared absolute risk scores and risk categories across each score using Pearson correlation and kappa statistics, respectively. Finally, we fit linear regression models to estimate the strength of association between each risk score and c-IMT. RESULTS Of 205 participants, half were females and median age was 49 years [interquartile range (IQR) 46-53]. Median CD4 count was 430 cells/mm (IQR 334-546), with median 7 years of antiretroviral therapy exposure (IQR 6.4-7.5). HIV-uninfected participants had a higher median systolic blood pressure (121 vs. 110 mm Hg), prevalent current smokers (18% vs. 4%, P = 0.001), higher median CVD risk scores (P < 0.003), and greater c-IMT (0.68 vs. 0.63, P = 0.003). Overall, FRS-BMI was highly correlated with other risk scores (all rho >0.80). In linear regression models, we found significant correlations between increasing CVD risk and higher c-IMT (P < 0.01 in all models). CONCLUSIONS In this cross-sectional study from Uganda, the FRS-BMI correlated well with standard risk scores and c-IMT. HIV-uninfected individuals had higher risk scores than HIV-infected individuals, and the difference seemed to be driven by modifiable factors.
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Affiliation(s)
- Anthony N Muiru
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Currently, Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Prossy Bibangambah
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Linda Hemphill
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Ruth Sentongo
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - June-Ho Kim
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Virginia A Triant
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - David R Bangsberg
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Currently, Oregon Health Sciences University-Portland State University School of Public Health, Portland, OR
| | - Alexander C Tsai
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- Chester M. Pierce, MD, Division of Global Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Jeffrey N Martin
- Epidemiology and Biostatistics, University of California, San Francisco, CA
| | - Jessica E Haberer
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Yap Boum
- Epicentre Research Base, Mbarara, Uganda
| | - Jorge Plutzky
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Peter W Hunt
- Epidemiology and Biostatistics, University of California, San Francisco, CA
| | - Samson Okello
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Mark J Siedner
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
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Solomon D, Sabin CA, Mallon PW, Winston A, Tariq S. Cardiovascular disease in women living with HIV: A narrative review. Maturitas 2018; 108:58-70. [DOI: 10.1016/j.maturitas.2017.11.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 11/09/2017] [Accepted: 11/13/2017] [Indexed: 12/14/2022]
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Husain NE, Noor SK, Elmadhoun WM, Almobarak AO, Awadalla H, Woodward CL, Mital D, Ahmed MH. Diabetes, metabolic syndrome and dyslipidemia in people living with HIV in Africa: re-emerging challenges not to be forgotten. HIV AIDS (Auckl) 2017; 9:193-202. [PMID: 29184449 PMCID: PMC5685138 DOI: 10.2147/hiv.s137974] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The current challenge in managing people living with human immunodeficiency virus (PLWHIV) includes the identification and monitoring for comorbid health risks associated with HIV and its treatment and longer survival. Dyslipidemia, diabetes mellitus and metabolic syndrome are increasingly seen in PLWHIV. OBJECTIVE In this narrative review, we aimed to summarize the current knowledge about diabetes, dyslipidemia and metabolic syndrome in PLWHIV in Africa and also to discuss the challenges that patients as well as health authorities in Africa may face. METHODS PubMed and Google scholar published-English literatures concerning earlier mentioned entities regardless of time limit were critically reviewed. RESULTS The prevalence of metabolic disorders in HIV population in Africa was estimated to range from 2.1% to 26.5% for diabetes and 20.2% to 43.5% for pre-diabetes, 13% to 58% for metabolic syndrome and 13% to 70% for dyslipidemia. CONCLUSION The management of metabolic disorders and cardiovascular disease risks related to HIV is complex especially in Africa due to healthcare resources, but our experience suggests that metabolic clinic is beneficial to patients and staff and should be an important part of HIV services especially as the older HIV population is increasing. In this context, cardiovascular risk assessment of HIV-infected patients will become an important component of care in developing countries in Africa and strategies are needed to deal with progressive increase in the epidemic of type 2 diabetes, dyslipidemia and metabolic syndrome.
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Affiliation(s)
- Nazik Elmalaika Husain
- Department of Pathology, Faculty of Medicine and Health Sciences, Omdurman Islamic University, Khartoum
| | | | - Wadie M Elmadhoun
- Department of Pathology, Faculty of Medicine and Health Sciences, Nile Valley University, Atbara
| | - Ahmed O Almobarak
- Department of Pathology, Faculty of Medicine, University of Medical Sciences and Technology
| | - Heitham Awadalla
- Department of Community Medicine, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Clare L Woodward
- Department of HIV and Genitourinary Medicine, Milton Keynes University Hospital, NHS Foundation Trust, Milton Keynes, UK
| | - Dushyant Mital
- Department of HIV and Genitourinary Medicine, Milton Keynes University Hospital, NHS Foundation Trust, Milton Keynes, UK
| | - Mohamed H Ahmed
- Department of Medicine and HIV Metabolic Clinic, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes, UK
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Feinstein MJ, Bogorodskaya M, Bloomfield GS, Vedanthan R, Siedner MJ, Kwan GF, Longenecker CT. Cardiovascular Complications of HIV in Endemic Countries. Curr Cardiol Rep 2017; 18:113. [PMID: 27730474 DOI: 10.1007/s11886-016-0794-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Effective combination antiretroviral therapy (ART) has enabled human immunodeficiency virus (HIV) infection to evolve from a generally fatal condition to a manageable chronic disease. This transition began two decades ago in high-income countries and has more recently begun in lower income, HIV endemic countries (HIV-ECs). With this transition, there has been a concurrent shift in clinical and public health burden from AIDS-related complications and opportunistic infections to those associated with well-controlled HIV disease, including cardiovascular disease (CVD). In the current treatment era, traditional CVD risk factors and HIV-related factors both contribute to an elevated risk of myocardial infarction, stroke, heart failure, and arrhythmias. In HIV-ECs, the high prevalence of persons living with HIV and growing prevalence of CVD risk factors will contribute to a growing epidemic of HIV-associated CVD. In this review, we discuss the epidemiology and pathophysiology of cardiovascular complications of HIV and the resultant implications for public health efforts in HIV-ECs.
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Affiliation(s)
- Matthew J Feinstein
- Division of Cardiovascular Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, USA.
| | - Milana Bogorodskaya
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Department of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Gerald S Bloomfield
- Division of Cardiology, Department of Medicine, Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Rajesh Vedanthan
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mark J Siedner
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Gene F Kwan
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Christopher T Longenecker
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Division of Cardiology, Department of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA
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Abstract
BACKGROUND Noncommunicable diseases are common among chronically infected patients with HIV in the developed world, but little is known about these conditions in African cohorts. We assessed the epidemiology of metabolic syndrome among young South African women during the first 3 years after HIV acquisition. METHODS A total of 160 women were followed prospectively in the CAPRISA 002 Acute Infection study. Metabolic syndrome was defined as a constellation of hyperlipidemia, hypertension, hyperglycemia/diabetes, and abdominal obesity. Time trends were assessed using generalized estimation equation models. RESULTS Median age was 24 years and body mass index 27 kg/m. Prevalence of metabolic syndrome at infection was 8.7% increasing to 19.2% over 36 months (P = 0.001). The proportion of women with body mass index >30 kg/m increased from 34.4% to 47.7% (P = 0.004), those with abnormal waist circumference and elevated blood pressure increased from 33.5% to 44.3% (P = 0.060) and 23.8% to 43.9% (P < 0.001), respectively. Incidence of metabolic syndrome was 9.13/100 person-years (95% CI: 6.02 to 13.28). Predictors of metabolic syndrome were age (per year increase odds ratio (OR) = 1.12; 95% CI: 1.07 to 1.16), time postinfection (per year OR = 1.47; 95% CI: 1.12 to 1.92), family history of diabetes (OR = 3.13; 95% CI: 1.71 to 5.72), and the human leukocyte antigen (HLA)-B*81:01 allele (OR = 2.95; 95% CI: 1.21 to 7.17), whereas any HLA-B*57 or B*58:01 alleles were protective (OR = 0.34; 95% CI: 0.15 to 0.77). HIV-1 RNA (OR = 0.89; 95% CI: 0.62 to 1.27) and CD4 count (OR = 1.03; 95% CI: 0.95 to 1.11) did not predict metabolic syndrome. CONCLUSIONS The high burden of metabolic conditions in young South African HIV-infected women highlights the need to integrate noncommunicable disease and HIV care programs. Interventions to prevent cardiovascular disease must start at HIV diagnosis, rather than later during the disease course.
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Ghehi C, Gabillard D, Moh R, Badje A, Kouamé GM, Oouttara E, Ahibo H, N’Takpé JB, Lecarrou J, Eholié SP, Anglaret X, Danel C. High correlation between Framingham equations with BMI and with lipids to estimate cardiovascular risks score at baseline in HIV-infected adults in the Temprano trial, ANRS 12136 in Côte d'Ivoire. PLoS One 2017; 12:e0177440. [PMID: 28582393 PMCID: PMC5459337 DOI: 10.1371/journal.pone.0177440] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 04/27/2017] [Indexed: 01/14/2023] Open
Abstract
Context Data on cardiovascular risk (CVR) score among HIV-infected patients in sub-Saharan Africa are scarce. Our first objective was to compare the CVR score of Framingham utilizing BMI and lipids at baseline, and secondary to assess evolution of CVR score over time at Month 30 in the Temprano trial. Methods HIV-infected adults with CD4 <800/mm3 without criteria for initiating ART were included and followed for 30 months in the Temprano trial, which assessed the benefits and risks of early antiretroviral treatment (ART) vs deferred ART. CVR score was estimated at baseline and Month-30 using Framingham equations with either BMI or lipids and classified as high (>20%), moderate (10–20%), and low risk (<10%). At baseline, we compare these two estimations utilizing the Pearson correlation test and analyze the increasing CV risk score over time by Proportional odds cumulative logit models for people attending the Month-30 (M30) visit. Results Among the 2056 patients, 78% were women, median age was 35 years, and median CD4 count was 464/mm3, 6.8% were obese, 6.3% had hypertension, 7.8% were smokers (1.8% women, 26.8% men), 19% had Total Cholesterol (TC) >5mmol/L, and 1% diabetes at baseline. At baseline the concordance between the two Framingham equations was excellent (r = 0.95; p<0.0001). Among the 1700 patients who attended M30 visit and with available data, 1.3% had a high CV risk score at baseline and 3.1% at M30 visit using Framingham equation with BMI. Adjusted odds ratio (aOR) of being at a higher CV risk score at M30 visit compared to a higher CV risk score at M0 visit was 1.35 (CI 95% 1.17–1.57). Stratified by sex, the increasing CV risk score was OR 1.73 (CI 95%: 1.30–2.29) for women and OR 1.24 (CI 95%: 1.02–1.50) for men. Early ART was not associated with an increasing CV risk score (p = 0.88). Results for the 1422 patients with Framingham equation using lipids were similar. Conclusion In a large trial evaluating early ART for HIV infection in Côte d’Ivoire, Framingham equation with BMI and lipids were highly correlated and CV risk score increases over time. Early ART was not significantly associated with this increasing CV risk score.
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Affiliation(s)
- Calixte Ghehi
- Programme PACCI - ANRS research site, Abidjan, Côte d’Ivoire
- Inserm U1219, Université de Bordeaux, Bordeaux, France
- Unité de Soins Ambulatoire et de Conseil (USAC), Abidjan, Côte d’Ivoire
| | | | - Raoul Moh
- Programme PACCI - ANRS research site, Abidjan, Côte d’Ivoire
- Inserm U1219, Université de Bordeaux, Bordeaux, France
- Service des Maladies Infectieuses et Tropicales, CHU de Treichville, Abidjan, Côte d’Ivoire
| | - Anani Badje
- Programme PACCI - ANRS research site, Abidjan, Côte d’Ivoire
- Inserm U1219, Université de Bordeaux, Bordeaux, France
| | | | - Eric Oouttara
- Inserm U1219, Université de Bordeaux, Bordeaux, France
| | - Hugues Ahibo
- Centre de Recherche et Diagnostic sur le SIDA, (Cedres) CHU de Treichville, Abidjan, Côte d’Ivoire
| | | | | | - Serge Paul Eholié
- Programme PACCI - ANRS research site, Abidjan, Côte d’Ivoire
- Inserm U1219, Université de Bordeaux, Bordeaux, France
- Service des Maladies Infectieuses et Tropicales, CHU de Treichville, Abidjan, Côte d’Ivoire
| | - Xavier Anglaret
- Programme PACCI - ANRS research site, Abidjan, Côte d’Ivoire
- Inserm U1219, Université de Bordeaux, Bordeaux, France
| | - Christine Danel
- Programme PACCI - ANRS research site, Abidjan, Côte d’Ivoire
- Inserm U1219, Université de Bordeaux, Bordeaux, France
- * E-mail:
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Muyanja D, Muzoora C, Muyingo A, Muyindike W, Siedner MJ. High Prevalence of Metabolic Syndrome and Cardiovascular Disease Risk Among People with HIV on Stable ART in Southwestern Uganda. AIDS Patient Care STDS 2016; 30:4-10. [PMID: 26683587 DOI: 10.1089/apc.2015.0213] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The objectives of this study were to determine the epidemiology and correlates of cardiovascular disease (CVD) risk among Ugandans on first-line antiretroviral therapy (ART). We conducted a cross-sectional study at an HIV clinic in southwestern Uganda. We enrolled adult patients on non-nucleoside-based ART regimens for a minimum of 2 years. We collected anthropometric and clinical measurements, smoking history, and blood for fasting lipid profile and blood sugar (FBS). Outcomes of interest were (1) presence of metabolic syndrome (at least two of the following: FBS >100 mg/dL, blood pressure of ≥130/85 mmHg, triglycerides ≥150 mg/dL, HDL <40 mg/DL, or waist circumference ≥94 cm in males or ≥80 cm in females); and (2) a Framingham score correlating to >5% 10-year CVD risk. Of the 250 participants enrolled, metabolic syndrome was detected in 145/250 (58%) of participants (62% in females and 50% in males). Forty-three participants (17%) had a Framingham risk correlating to a 5% or greater risk for CVD within 10 years (26% in males and 13% in females). In multivariate analyses, being female (AOR 3.13; 95% CI: 1.0-9.70; p = 0.04) and over 40 years of age (AOR 1.78; 95% CI: 1.00-3.17; p = 0.05) was independently associated with having metabolic syndrome. We found no independent risk factors for a Framingham risk score 10-year risk exceeding 5%, or associations between ART regimen and CVD risk profiles. We conclude that metabolic abnormalities are common among patients on first-line ART in rural Uganda, and appear to be more common in women than men.
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Affiliation(s)
- Daniel Muyanja
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Conrad Muzoora
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Anthony Muyingo
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Winnie Muyindike
- Department of Internal Medicine, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Mark J. Siedner
- Department of Infectious Disease and Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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