Prevalence of low high-density lipoprotein among young adults receiving antiretroviral therapy in Zambia: An opportunity to consider non-communicable diseases in resource-limited settings

Abstract

Background With the introduction of effective antiretroviral therapy (ART), people living with HIV (PLWH) are surviving longer and are at risk for developing metabolic abnormalities that contribute to cardiovascular disease (CVD). In Sub-Saharan Africa (SSA), there is a paucity of epidemiological data on lipid profiles among young adults receiving ART. This study aimed to estimate the prevalence of low high-density lipoprotein cholesterol (HDL-c), a cardioprotective lipid class, and whether it differed by age among adults on ART in Livingstone, Zambia. Methods From April to December 2019, we conducted a cross-sectional study of 597 PLWH [n = 58 aged 18–24 years (young adults); n = 539 aged ≥25 years (adults)] on ART for ≥6 months. Data collected included demographic and lifestyle information, anthropometrics, viral load (VL), CD4 count, blood pressure, lipid profiles and fasting/random blood glucose. Clinical measures were defined as: low HDL-c [<1.0 mmol/L for men, <1.3 for women], increased waist circumference (WC) [≥94 cm for men, ≥80 cm for women], high triglycerides (TG) [≥1.7 mmol/l], and virological failure (VF) [VL ≥1000 copies/μl]. We used logistic regression to examine the association between age and low HDL-c after adjusting for multiple variables. Results Among the young adults, 60% (35/58) were women, median (25th, 75th percentile) age 21 years (18, 23), and median time on ART 116 months (60, 144). Among adults, 63% (342/539) were women, median age 46 years (40, 53) and median time on ART 108 months (60, 144). Young adults had a lower CD4 count compared to adults (median, 492 vs. 568 cells/μL, p = 0.010) and higher prevalence of VF (29% vs. 17%, p = 0.016). In young adults, prevalence of low HDL-c was significantly higher than in adults (63 vs. 38%, p<0.001). A high proportion of young adults (75%) and adults (58%) with low HDL-c were on dolutegravir (DTG)-based ART regimens. After adjusting for sex, duration on ART, WC, body mass index, ART regimen, VF, CD4 count, low density lipoprotein cholesterol, blood pressure and smoking, young adults were significantly more likely than adults to have low HDL-c (odds ratio 2.93; 95% confidence interval 1.46–5.86). Conclusion Low HDL-c is highly prevalent among young adult with HIV in SSA independent of other risk factors for metabolic derangements. Lipid abnormalities among young PLWH may contribute to the early development of cardiovascular diseases in this population. This highlights the need to consider low HDL-c in the quest to reduce CVD risk among young adults on ART in SSA.

Altered Lipid Profiles and Vaccine Induced-Humoral Responses in Children Living With HIV on Antiretroviral Therapy in Tanzania

“…These observations were further confirmed in a multivariate regression analysis, after adjusting for confounders. Our findings are comparable to prior studies that have analysed blood lipid disorders in adolescents and adults living with HIV living in similar settings ( Ombeni and Kamuhabwa, 2016 ; Fiseha et al., 2021 ; Hamooya et al., 2021 ; Tilahun et al., 2021 ). A recent Zambian cross-sectional study found a high prevalence (63%) of low HDL-c in ART experienced young adults living with HIV aged 18-24 years and that these young individuals were about three times more likely to have low HDL-c than older individuals ( Hamooya et al., 2021 ).…”

“…Our findings are comparable to prior studies that have analysed blood lipid disorders in adolescents and adults living with HIV living in similar settings ( Ombeni and Kamuhabwa, 2016 ; Fiseha et al., 2021 ; Hamooya et al., 2021 ; Tilahun et al., 2021 ). A recent Zambian cross-sectional study found a high prevalence (63%) of low HDL-c in ART experienced young adults living with HIV aged 18-24 years and that these young individuals were about three times more likely to have low HDL-c than older individuals ( Hamooya et al., 2021 ). Also similar to our findings, the prevalence of low HDL-c and hypertriglyceridemia has also been observed in other studies with similar settings to be higher on ART experienced HIV+ than HIV- children ( Mandal et al., 2016 ; Dirajlal-Fargo et al., 2021 ).…”

“…Previous studies (mostly done in HIV+ adults) have linked the use of protease (PI)-based ART with increased dyslipidaemia ( Cunha, 2015 ; De Lima et al., 2018 ; Irira et al., 2020 ; Belete et al., 2021 ; Hamooya et al., 2021 ; Tilahun et al., 2021 ). HIV+ individuals on PI-based regimen are more likely to have higher concentrations of triglycerides than those who were on non-PI therapies ( Kazooba et al., 2017 ; Belete et al., 2021 ).…”

Hypertension and human immunodeficiency virus: A paradigm for epithelial sodium channels?

“…Metabolic risks such as weight gain, dyslipidemia and hyperglycemia, which are part of the metabolic syndrome, have been identified in patients on cART which can alter normal endothelial function ( 72 , 134 , 135 , 154 , 155 ). Sax et al showed that weight gain was greater in more recent trials and with the use of newer integrase strand transfer inhibitor (INSTIs) such as dolutegravir than protease inhibitors ( 135 ).…”

“…In addition, aldosterone stimulates both the innate and adaptive immune systems leading to macrophages and T cells accumulation in the kidneys, heart, and vasculature which contribute to the development of hypertension and other cardiometabolic diseases ( 165 ). The persistence of immune activation in HIV ( 144 , 166 ) and the metabolic toxicity associated with cART ( 72 , 134 , 135 , 154 , 155 ) may potentially play an additive or multiplicative role on the effects of aldosterone and ENaC activation, and therefore increase the risk of hypertension in PWH. Given the widespread use of dolutegravir, it is worth prospectively investigating the impact of weight gain on ENaC function in PWH.…”