Assessment of cardiovascular risk factors in people with HIV infection treated with ART in rural South Africa: a cross sectional study

Abstract

BackgroundThe risk of cardiovascular diseases (CVD) in human immunodeficiency virus (HIV) infected people on antiretroviral therapy (ART) from some rural parts of Africa is not well known. We assessed CVD risk factors, the estimated 5-year Data collection on adverse effects of anti-HIV drugs (DA.) risk score and the 10-year Framingham risk score in persons with HIV infection on ART in a rural area in South Africa.Methods A cross-sectional study in which the data on demographic, lifestyle, and chronic disease were collected using the World Health Organization Stepwise approach to surveillance questionnaire. Biochemical parameters were tested using standard biochemical methods. CD4 counts were performed using PIMA analyser and viral load was tested using the branched deoxyribonucleic acid technique. Student t test and Chi square test were used on continuous and categorical variables respectively. Bivariate and multivariate logistic regression were used to analyze predictors of CVD risk factors. Estimates of 5 and 10-year CVD risk were calculated using online tools. The Cohen’s kappa coefficient was used to assess the agreement between CVD risk equations.ResultsThe mean age of participants was 44.8 ± 11.8 years; 79.9 % were females. Most of the participants (85 %) had an undetectable viral load and a mean CD4 count of 462 ± 235 cell/mm3. The most common CVD risk factors were low high density lipoprotein cholesterol (HDL-C) (43.8 %), hypercholesterolaemia (33.2 %) and a high Apolipoprotein (Apo) B/ApoA ratio (45.4 %).Using the Framingham equation, 6.7 % of participants had a moderate to high 10-year CVD risk while the DAD risk equation showed that 31.1 % of participants had a moderate to high 5-year CVD risk. Most participants had a low CVD risk by both risk equations. The level of agreement between the two risk equations was 73.8 % (k = 0.23; 95 % CI 0.10–0.35; p value 0.001).ConclusionCVD risk factors were common among this rural population on ART. The high proportion of participants with a moderate to high CVD risk, observed with the DAD risk equation, clearly represents a considerable health burden that can possibly be reduced by increasing educational programs on CVD prevention for people on ART. There is however a need to develop and evaluate a race/ethnicity-specific CVD risk estimation tool for HIV infected Africans.

Cardiovascular risk in an HIV-infected population in India

“…While a recent study of an Asian cohort classified a much greater percentage of people as high risk,22 our results are consistent with findings from South Africa 23. However, a noteworthy difference between our study population and these two studies is the younger age of our study participants.…”

<div>Changes in coronary heart disease risk profiles of HIV patients in Zimbabwe over 9 months: a follow-up study</div>

“…A very low proportion of patients (2.5%, n=5) had high overall Framingham risk score >20% at baseline,21 and this low frequency did not change much at follow-up (4.8%, n=7). This result agrees with a report from South Africa,44 but results are lower than those from Ugandan males45 and from developed countries, where ART is much more readily available 46–48. Age, lipids, and high SBP are associated with increasing Framingham risk scores, suggesting that CHD risk and other noncommunicable diseases may become more important in our setting due to an aging HIV population on ART, unless efforts are made to contain modifiable risk factors, such as blood pressure, lipids, and BMI, as suggested by literature 39,49,50.…”

Adverse drug reaction in HIV-infected people treated with HAART in Maringá, Southern Brazil

“…Lipodystrophy is characterized by changes in body fat distribution including increased waist circumference, increased breast size, and, fat accumulation in the neck, cheeks, and buttocks. Hyperlipidemia/dyslipidemia, hyperglycemia, and lipodystrophy are cardiovascular risk factors in people with HIV infection treated with HAART [17][18][19].…”