HIV and risk of cardiovascular disease in sub-Saharan Africa: Rationale and design of the Ndlovu Cohort Study

Abstract

Background The largest proportion of people living with HIV resides in sub-Saharan Africa (SSA). Evidence from developed countries suggests that HIV infection increases the relative risk of cardiovascular disease (CVD) by up to 50%. Differences in lifestyle, gender distribution, routes of HIV transmission and HIV subtype preclude generalisation of data from Western countries to the SSA situation. The Ndlovu Cohort Study aims to provide insight into the burden of cardiovascular risk factors and disease, the mechanisms driving CVD risk and the contribution of HIV infection and its treatment to the development of CVD in a rural area of SSA. Design The Ndlovu Cohort Study is a prospective study in the Moutse area, Limpopo Province, South Africa. Methods A total of 1000 HIV-positive and 1000 HIV-negative participants aged 18 years and older with a male to female ratio of 1:1 will be recruited. Measurements of CVD risk factors and HIV-related characteristics will be performed at baseline, and participants will be followed-up over time at 6-month intervals. The burden of CVD will be assessed with repeated carotid intima-media thickness and pulse wave velocity measurements, as well as by recording clinical cardiovascular events that occur during the follow-up period. Conclusion This project will contribute to the understanding of the epidemiology and pathogenesis of CVD in the context of HIV infection in a rural area of SSA. The ultimate goal is to improve cardiovascular risk prediction and to indicate preventive approaches in the HIV-infected population and, potentially, for non-infected high-risk populations in a low-resource setting.

Heart Rate Variability, HIV and the Risk of Cardiovascular Diseases in Rural South Africa

“…Routine physical examination was used to assess CVD risk factors. Full study procedures of the NCS have been described previously [15].…”

“…Fasting glucose, triglycerides, total, HDL and LDL cholesterol were measured by Toga labs, South Africa. In HIV-uninfected subjects, HIV status was measured according to the NCS protocol [15].…”

Sex Differences in Select Non-communicable HIV-Associated Comorbidities: Exploring the Role of Systemic Immune Activation/Inflammation

“…However, the epidemiology of HIV-associated CVD in Sub-Saharan Africa may be expected to change over the next several years as access to ART expands and increased urban migration ushers in the adoption of a more atherogenic diet. Moving forward, the prospective Ndlovu Cohort Study (enrolling 1000 PLHIV and 1000 control subjects at a 1:1 M/F ratio in Limpopo Province, South Africa) will shed additional light on CVD risk factors and the burden of CVD among individuals aging with HIV in the region(55). Sex-stratified analyses in this study would offer considerable insight on region-specific sex-differences in HIV-associated CVD.…”

The Montreal Cognitive Assessment–Basic (MoCA-B) is not a reliable screening tool for cognitive decline in HIV patients receiving combination antiretroviral therapy in rural South Africa

“…Patients were recruited from the Ndlovu cohort study; details of the methods used in that study have been published elsewhere (Vos et al, 2017). For this sub-study, a random sample of HIVpositive and HIV-negative study participants who met the eligibility criteria were contacted by telephone and asked to participate.…”