Short-term and long-term cardiovascular risk, metabolic syndrome and HIV in Tanzania

Abstract

Objective To compare short and long term cardiovascular disease (CVD) risk scores and prevalence of metabolic syndrome in HIV-infected adults receiving and not receiving antiretroviral therapy (ART) to HIV-negative controls. Methods A cross-sectional study including: 151 HIV-infected, ART-naive, 150 HIV-infected on ART and 153 HIV-negative adults. Traditional cardiovascular risk factors were determined by standard investigations. The primary outcome was ACC/AHA ASCVD Risk Estimator lifetime CVD risk score. Secondary outcomes were ASCVD 10-year risk, Framingham risk scores, statin indication and metabolic syndrome. Results Compared to HIV-negative controls, more HIV-infected adults on ART were classified as high lifetime CVD risk (34.7% vs 17.0%, p<0.001) although 10-year risk scores were similar, a trend which was similar across multiple CVD risk models. In addition, HIV-infected adults on ART had a higher prevalence of metabolic syndrome vs HIV-negative controls (21.3% vs 7.8%, p=0.008), with 2 common clusters of risk factors. More than one-quarter (28.7%) of HIV-infected Tanzanian adults on ART meet criteria for statin initiation. Conclusions HIV-infected ART-treated individuals have high lifetime cardiovascular risk, and this risk seems to develop rapidly in the first 3–4 years of ART as does the development of clusters of metabolic syndrome criteria. These data identify a new subgroup of low short-term/high lifetime risk HIV-infected individuals on ART who do not currently meet criteria for CVD risk factor modification but require further study.

Cardiovascular risk in an HIV-infected population in India

“…Thirty-two per cent of our study participants qualify for statin therapy under current ACC/AHA guidelines but only 2% were currently on statins. Juxtaposing our findings with those of a similar study from Tanzania24 shows an almost twofold higher statin requirement for our Indian HIV-infected population. While the proportion of participants that qualify for statins prescription decreases to 11% when using the NICE guidelines, our findings still highlight the deficit in therapeutic preventive services and a need to integrate them with the national HIV response.…”

Prevalence of hypertension and cardiovascular risk factors among long‐term AIDS survivors: A report from the field

“…Among patients who were screened for all CVDRFs, 31% (53/172) were diagnosed with at least two CVDRFs, with the most common dyad of risks being HTN with either HC or DM (18% and 3%, respectively). CVDRF clustering in HIV‐infected individuals on ART has been previously observed in other resource‐limited settings and has been suggested to increase with duration on ART . Analysis of clustering patterns has been suggested as a method for differentiation and adjustment for true CVD risk in HIV‐infected patients …”

“…31 Analysis of clustering patterns has been suggested as a method for differentiation and adjustment for true CVD risk in HIV-infected patients. 5,51 A limitation of our study was the lack of an available control group because routine CVDRF screening was implemented only for HIV-infected patients. A second limitation is the lack of CVDRF screening at time of ART initiation.…”

Use of hypnotics and the risk of or mortality from heart disease: a meta-analysis of observational studies

“…When a total of 1,682 people who had no HIV at baseline were followed for about 80 months [ 35 ], BZD use was significantly associated with an increased rate of HIV seroconversion (adjusted risk ratio, 1.50; 95% CI, 1.01 to 2.24). A cross-sectional study enrolling a total 354 subjects [ 36 ] showed that cardiovascular disease occurrence was higher in HIV-infected patients than HIV-negative subjects. Another virus which can connect use of hypnotics and the risk of heart disease can be hepatitis C virus (HCV).…”