Treated HIV Infection and Progression of Carotid Atherosclerosis in Rural Uganda: A Prospective Observational Cohort Study

Siedner, Mark J.; Bibangambah, Prossy; Kim, June-Ho; Lankowski, Alexander; Chang, Jonathan L.; Yang, Isabelle T.; Kwon, Douglas S.; North, Crystal M.; Triant, Virginia A.; Longenecker, Christopher T.; Ghoshhajra, Brian; Peck, Robert; Sentongo, Ruth; Gilbert, Rebecca F; Kakuhikire, Bernard; Boum, Yap; Haberer, Jessica; Martin, Jeffrey N.; Tracy, Russell P.; Hunt, Peter W.; Bangsberg, David R.; Tsai, Alexander C.; Hemphill, Linda; Okello, Samson

doi:10.1161/jaha.120.019994

Cited by 12 publications

(13 citation statements)

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“…Notably, we previously demonstrated no association in this cohort between HIV serostatus and cIMT thickness or progression [ 11 ]. While both cIMT and carotid plaque are considered predictors of atherosclerotic disease events, they vary in pathophysiology whereby cIMT represents intimal medial thickening with very early atherosclerotic changes in the intima but also, potentially, smooth muscle hypertrophy and/or hyperplasia in the media which is more related to hypertension.…”

Section: Discussionmentioning

confidence: 71%

“…To do so, we conducted carotid ultrasound to detect carotid plaque, a validated surrogate marker and predictor of atherosclerotic CVD risk [ 9 , 10 ]. Previous studies have shown that there was no difference in carotid intima media thickness (cIMT), another predictor of atherosclerotic CVD risk, between PLWH and uninfected comparators [ 11 , 12 ]. Other cohorts, however, like the MultiCenter AIDS Cohort Stuudy (MACS) in the US have shown that while there was no difference in cIMT, there was a difference in carotid plaque [ 13 ] and this remains unstudied in Uganda.…”

Section: Introductionmentioning

confidence: 99%

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Prevalence and correlates of carotid plaque in a mixed HIV-serostatus cohort in Uganda

Bibangambah

Hemphill

Acan

et al. 2021

BMC Cardiovasc Disord

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Background The extent to which the risk of atherosclerotic cardiovascular disease (ACVD) is increased among people living with HIV (PLWH) in sub-Saharan Africa remains unknown. Setting Cross-sectional analysis nested within the Ugandan Noncommunicable Diseases and Aging Cohort, including PLWH in rural Uganda > 40 years taking antiretroviral therapy (ART) for at least 3 years, and a population-based control group of HIV-uninfected age- and sex-matched persons. Methods We conducted carotid ultrasonography and collected ACVD risk factor data. Our outcome of interest was carotid plaque, defined as > 1.5 mm thickness from the intima-lumen interface to the media-adventitia interface. We fit multivariable logistic regression models to estimate correlates of carotid plaque including HIV-specific and traditional cardiovascular risk factors. Results We enrolled 155 (50.2%) PLWH and 154 (49.8%) HIV-uninfected comparators, with a mean age of 51.4 years. Among PLWH, the median CD4 count was 433 cells/mm3 and 97.4% were virologically suppressed. Carotid plaque prevalence was higher among PLWH (8.4% vs 3.3%). HIV infection (aOR 3.90; 95% CI 1.12–13.60) and current smokers (aOR 6.60; 95% CI 1.22–35.80) had higher odds of carotid plaque, whereas moderate (aOR 0.13, 95% CI 0.01–1.55) and vigorous intensity of physical activity (aOR 0.34, 95% CI 0.07–1.52) were associated with decreased odds of carotid plaque. Conclusion In rural Uganda, PLWH have higher prevalence of carotid plaque compared to age- and sex-matched HIV-uninfected comparators. Future work should explore how biomedical and lifestyle modifications might reduce atherosclerotic burden among PLWH in the region.

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Section: Discussionmentioning

confidence: 71%

Section: Introductionmentioning

confidence: 99%

Prevalence and correlates of carotid plaque in a mixed HIV-serostatus cohort in Uganda

Bibangambah

Hemphill

Acan

et al. 2021

BMC Cardiovasc Disord

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“…In addition to lower rates of obesity, people living with HIV reported less smoking, greater physical activity and higher fruit and vegetable consumption as compared to HIV‐negative participants. A lower CVD risk factor profile among participants living with HIV as compared to HIV‐negative participants has been reported elsewhere in Uganda and South Africa with differences potentially a result of an increased access to routine healthcare and associated CVD preventative counselling for people living with HIV as compared to the general population [32, 33]. Further research is needed to determine the exact reasons for the difference in CVD risk profiles and particularly the role that access to routine healthcare may play in the difference.…”

Section: Discussionmentioning

confidence: 94%

Prevalence of cardiovascular risk factors by HIV status in a population‐based cohort in South Central Uganda: a cross‐sectional survey

et al. 2022

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Introduction: Cardiovascular disease is one of the leading causes of mortality for people living with HIV, but limited population-based data are available from sub-Saharan Africa. This study aimed to determine the prevalence of key cardiovascular disease risk factors, 10-year risk of cardiovascular disease and type 2 diabetes mellitus through risk scores by HIV status, as well as investigate factors associated with hyperglycaemia, hypertension and dyslipidaemia in South-Central Uganda. Methods: A cross-sectional study was conducted in 37 communities of the population-based Rakai Community Cohort Study from May 2016 to May 2018. In total, 990 people living with HIV and 978 HIV-negative participants aged 35-49 years were included. Prevalence estimates and 10-year cardiovascular and type 2 diabetes risk were calculated by sex and HIV serostatus. Multivariable logistic regression was used to determine associations between socio-demographic, lifestyle and body composition risk factors and hyperglycaemia, hypertension and dyslipidaemia. Results: Overweight (21%), obesity (9%), abdominal obesity (15%), hypertension (17%) and low high-density lipoprotein (HDL) (63%) were the most common cardiovascular risk factors found in our population. These risk factors were found to be less common in people living with HIV apart from hypertension. Ten-year risk for cardiovascular and type 2 diabetes mellitus risk was low in this population with <1% categorized as high risk. In HIV-adjusted multivariable analysis, obesity was associated with a higher odds of hypertension (odds ratio [OR] = 2.31, 95% confidence interval [CI] 1.35-3.96) and high triglycerides (OR = 2.08, CI 1.25-3.47), and abdominal obesity was associated with a higher odds of high triglycerides (OR = 2.55, CI 1.55-4.18) and low HDL (OR = 1.36, CI 1.09-1.71). A positive HIV status was associated with a lower odds of low HDL (OR = 0.43, CI 0.35-0.52). Conclusions: In this population-based study in Uganda, cardiovascular risk factors of obesity, abdominal obesity, hypertension and dyslipidaemia were found to be common, while hyperglycaemia was less common. Ten-year risk for cardiovascular and type 2 diabetes mellitus risk was low. The majority of cardiovascular risk factors were not affected by HIV status. The high prevalence of dyslipidaemia in our study requires further research.

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“…Two recent studies from sub-Saharan Africa, where more than two of three of all WLWH reside, provide a broader picture of subclinical atherosclerosis in PLWH outside of high-income countries [79 ▪ ,80]. In these studies, neither HIV nor sex was a predictor of CIMT progression over 4 years in Uganda [80].…”

Section: Mechanisms Of Cardiovascular Diseasementioning

confidence: 95%

Cardiovascular disease risk in women living with HIV

Kentoffio

Temu

Shakil

et al. 2022

Current Opinion in HIV and AIDS

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Purpose of reviewTo synthesize current evidence on the impact of cardiovascular disease among women living with HIV (WLWH) with a particular focus on disease prevalence, mechanisms and prevention. Recent findingsHIV-related cardiovascular disease risk is 1.5-fold to 2-fold higher for women than for men. Mechanisms of enhanced risk are multifactorial and include reinforcing pathways between traditional risk factors, metabolic dysregulation, early reproductive aging and chronic immune activation. These pathways influence both the presentation of overt syndromes of myocardial infarction, stroke and heart failure, as well as subclinical disease, such as microvascular dysfunction and cardiac fibrosis. Cardiovascular disease, therefore, remains a consistent threat to healthy aging among WLWH.

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Treated HIV Infection and Progression of Carotid Atherosclerosis in Rural Uganda: A Prospective Observational Cohort Study

Cited by 12 publications

References 73 publications

Prevalence and correlates of carotid plaque in a mixed HIV-serostatus cohort in Uganda

Prevalence and correlates of carotid plaque in a mixed HIV-serostatus cohort in Uganda

Prevalence of cardiovascular risk factors by HIV status in a population‐based cohort in South Central Uganda: a cross‐sectional survey

Cardiovascular disease risk in women living with HIV

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