Burden of subclinical carotid atherosclerosis and vascular risk factors among people living with HIV in Ghana

Nichols, Michelle; Agyei, Benedict; Singh, Arti; Ennin, Eugenia; Nyantakyi, Adu Darko; Asibey, Shadrack Osei; Tagge, Raelle; Gebregziabher, Mulugeta; Jenkins, Carolyn; Ovbiagele, Bruce

doi:10.1016/j.jns.2018.12.026

Cited by 28 publications

(28 citation statements)

References 49 publications

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“…Furthermore, enhancing adherence to CVD medicines through mobile health technology as has been shown in the context of stroke in Ghana would all require systematic testing through clinical trials to assess their efficacy and potential implementation in our setting. On a much broader scale, our previous report shows a highly prevalent but poorly controlled hypertension rate in the general population based on evidence gleaned from our HIV‐negative sample . This may explain why we found that HIV per se was not to be independently associated with stroke occurrence in a low endemic country such as Ghana, although the burden of stroke and poor outcomes continue to rise in the subregion due to a myriad of factors hampering the control of key CVD risk factors …”

Section: Discussionmentioning

confidence: 67%

“…The Evaluation of Vascular Event Risk while on Long‐term Anti‐retroviral Suppressive Therapy (EVERLAST) Study seeks to characterize the burden of cardiovascular risk among patients with HIV on cART in Ghana. We have shown in a recent report among Ghanaian PLWH that hypertension was associated with subclinical atherosclerosis at a carotid intimal media thickness (CIMT) cutoff value of 1.00 mm . Carotid atherosclerosis is a harbinger of MACE in the HIV population .…”

Section: Introductionmentioning

confidence: 93%

“…We have shown in a recent report among Ghanaian PLWH that hypertension was associated with subclinical atherosclerosis at a carotid intimal media thickness (CIMT) cutoff value of 1.00 mm. 22 Carotid atherosclerosis is a harbinger of MACE in the HIV population. 2 Hence, characterizing the epidemiology of hypertension among PLWH in SSA is essential to guide the development of evidence-based interventions to mitigate this cardinal risk factor for CVDs.…”

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confidence: 99%

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Characteristics of hypertension among people living with HIV in Ghana: Impact of new hypertension guideline

Nichols

Singh

Hardy

et al. 2019

J of Clinical Hypertension

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Data on the burden of hypertension among people living with HIV (PLWH) in Africa are limited, especially after new expert consensus hypertension guidelines were published in 2017. The authors sought to assess the prevalence and factors associated with hypertension among PLWH. This is a cross‐sectional study involving PLWH on combination antiretroviral therapy (cART) (n = 250) compared with sex‐matched cART‐naïve PLWH (n = 201) in Ghana. Hypertension was defined as blood pressure ≥ 140/90 mm Hg or use of antihypertensive drugs. The authors also assessed the prevalence and predictors associated with hypertension using the recent guideline recommended cutoff BP ≥ 130/80 mm Hg. Multivariate logistic regression models were fitted to identify factors associated with hypertension among PLWH. The mean age of PLWH on cART was 45.7 ± 8.6 years, and 42.9 ± 8.8 years among PLWH cART‐naive with 81% of study participants being women. The prevalence of hypertension among PLWH on cART and PLWH cART‐naïve was 36.9% and 23.4%, P = 0.002 at BP ≥ 140/90 mm Hg and 57.2% and 42.3%, respectively, P = 0.0009, at BP ≥ 130/80 mm Hg. Factors associated with hypertension at BP ≥ 140/90 mm Hg in the PLWH group with adjusted odds ratio (95% CI) were increasing age, 2.08 (1.60‐2.71) per 10 years, and body mass index, 1.53 (1.24‐1.88) per 5 kg/m2 rise. At BP ≥ 130/80 mm Hg, cART exposure, aOR of 1.77 (95% CI: 1.20‐2.63), family history of hypertension, aOR of 1.43 (1.12‐1.83), and hypertriglyceridemia, aOR of 0.54 (0.31‐0.93), were associated with hypertension. Among PLWH, cART exposure was associated with higher prevalence of hypertension per the new guideline definition, a finding which warrants further investigation and possible mitigation.

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Section: Discussionmentioning

confidence: 67%

Section: Introductionmentioning

confidence: 93%

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confidence: 99%

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Characteristics of hypertension among people living with HIV in Ghana: Impact of new hypertension guideline

Nichols

Singh

Hardy

et al. 2019

J of Clinical Hypertension

Self Cite

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“…37 A higher prevalence has been reported, however, in both a Senegalese cohort (28%) and a recent Ghanaian cohort (40%), which may be due to differences in baseline age and sex. 9,15,38 These findings underscore the fact that the burden of hypertension is likely to rise with an aging HIV population and should attract proportionate public health and clinical response to curb the projected increase in prevalence and its associated disease burden.…”

Section: Comparison With Previous Researchmentioning

confidence: 89%

“…7 Routine assessment and monitoring of CVD risk among HIV patients globally is generally suboptimal 8 with only one published report from Ghana, in particular. 9 This current study sought to fill this gap in knowledge and to estimate the CVD burden of HIV patients presenting for routine visits at the largest HIV clinic in central Ghana.…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular risk factors among Ghanaian patients with HIV: A cross‐sectional study

Appiah

Huffman

Nguah

et al. 2019

Clinical Cardiology

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BackgroundCardiovascular disease (CVD) poses a significant cause of morbidity and mortality among people living with human immunodeficiency virus (HIV). However, data are limited on CVD risk burden among HIV patients in Ghana. We describe the age‐ and sex‐adjusted prevalence of CVD risk factors among HIV patients in Ghana.MethodsFrom January 2013 to May 2014, we identified eligible HIV patients 18 years and older, as well as uninfected adult blood donors presenting to the Komfo Anokye Teaching Hospital as controls. Using a standardized protocol, we collected demographic, clinical, laboratory, and electrocardiographic data. We created multivariable logistic regression models to compare the prevalence of abnormal risk factors between the two groups.ResultsWe recruited 345 patients with HIV (n = 173 on HAART, n = 172 not on HAART) and 161 uninfected adult blood donors. Patients with HIV were older (mean [SD] age: 41 [11] vs 32 [11] years) and were more likely to be female (72% vs 28%) than blood donors. Among patients on HAART, median (interquartile range) treatment duration was 17 (4‐52) months. The prevalence of hypertension, hypercholesterolemia, and diabetes mellitus among HIV patients was 9%, 29%, and 5%, respectively, compared with 5%, 15%, and 0.6% among uninfected blood donors. Smoking was the least prevalent CVD risk factor (1%‐2%). After adjustment for age, sex, and body mass index, HIV patients had a 10‐fold higher odds of prevalent diabetes compared with controls, (adjusted OR = 10.3 [95% CI: 1.2, 86.7]).ConclusionCVD risk factors are common among HIV patients in Ghana, demonstrating the urgent need for creation and implementation of strategic CVD interventions.

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Does Engagement in HIV Care Affect Screening, Diagnosis, and Control of Noncommunicable Diseases in Sub-Saharan Africa? A Systematic Review and Meta-analysis

Kileel,

Zheng,

Bor

et al. 2024

AIDS Behav

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Low- and middle-income countries are facing a growing burden of noncommunicable diseases (NCDs). Providing HIV treatment may provide opportunities to increase access to NCD services in under-resourced environments. We conducted a systematic review and meta-analysis to evaluate whether use of antiretroviral therapy (ART) was associated with increased screening, diagnosis, treatment, and control of diabetes, hypertension, chronic kidney disease, or cardiovascular disease among people living with HIV in sub-Saharan Africa (SSA). A comprehensive search of electronic literature databases for studies published between 01 January 2011 and 31 December 2022 yielded 26 studies, describing 13,570 PLWH in SSA, 61% of whom were receiving ART. Random effects models were used to calculate summary odds ratios (ORs) of the risk of diagnosis by ART status and corresponding 95% confidence intervals (95% CIs), where appropriate. ART use was associated with a small but imprecise increase in the odds of diabetes diagnosis (OR 1.07; 95% CI 0.71, 1.60) and an increase in the odds of hypertension diagnosis (OR 2.10, 95% CI 1.42, 3.09). We found minimal data on the association between ART use and screening, treatment, or control of NCDs. Despite a potentially higher NCD risk among PLWH and regional efforts to integrate NCD and HIV care, evidence to support effective care integration models is lacking.

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Burden of subclinical carotid atherosclerosis and vascular risk factors among people living with HIV in Ghana

Cited by 28 publications

References 49 publications

Characteristics of hypertension among people living with HIV in Ghana: Impact of new hypertension guideline

Characteristics of hypertension among people living with HIV in Ghana: Impact of new hypertension guideline

Cardiovascular risk factors among Ghanaian patients with HIV: A cross‐sectional study

Does Engagement in HIV Care Affect Screening, Diagnosis, and Control of Noncommunicable Diseases in Sub-Saharan Africa? A Systematic Review and Meta-analysis

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