Cardiometabolic risk among hiv-positive Ugandan adults: prevalence, predictors and effect of long-term antiretroviral therapy

Abstract

IntroductionWe investigated the prevalence, predictors of and effect of Antiretroviral Therapy (ART) regimen on cardiometabolic risk among HIV-positive Ugandan adults at enrolment into a prospective cohort to study the Complications of Long-Term ART (CoLTART).MethodsWe collected data on cardiometabolic risk factors including dyslipidemia, hypertension, hyperglycemia, obesity and calculated the mean atherogenic index for Plasma (AIP) and 10 year Framingham risk score (FHS). Exposures were: ART regimen, duration on ART, demographic, socio-economic, behavioral, and life-style factors including smoking, physical activity and diet (including fruit and vegetables consumption).ResultsWe enrolled 1024 participants, 65% female, mean age was 44.8 years (SD 8.0) and median duration on ART was 9.4 years (IQR 6.1-9.8). The prevalence of abdominal obesity was 52.6%, BMI≥25 kg/m2 -26.1%, hypertension-22.6%, high AIP-31.3% and FHS above 10% was 16.6%. The prevalence of low High Density Lipoprotein (HDL) was 37.5%, high Total cholesterol (Tc)-30.2%, high Low Density Lipoprotein (LDL) -23.6%, high Triglycerides (TG)-21.2%, low physical activity-46.4% and alcohol consumption-26.4%. In multivariate linear regression analyses, increasing age was associated with higher mean Tc, HDL, LDL, FHS (P<0.001) and hyperglycemia (p<0.005). In multivariate logistic regression analyses, Protease Inhibitor (PI) containing regimens were significantly associated with higher risks of abnormal: Tc, LDL, TG, AIP, abdominal obesity, hypertension, low HDL and lower risk of a FHS >10% compared to the non PI regimen.ConclusionART increases cardiometabolic risk. Integration of routine assessment for cardiometabolic risk factors and preventive interventions into HIV care programs in resource-limited settings is recommended.

Prevalence of hypertension and cardiovascular risk factors among long‐term AIDS survivors: A report from the field

“…in Malawi (median ART duration = 11.6 years) and 22.6% in Uganda (median ART duration = 9.4 years). 32,35 Our findings suggest the higher prevalence of HTN among our cohort may be related to our cohort's longer duration on ART (median duration 12.1 years) and…”

“…27 The prevalence of HTN among HIV-infected adults on ART in other resource-limited settings ranges from 17% to 46%, which likely reflects differences in baseline characteristics, duration of infection and treatment. 1,[28][29][30][31][32][33][34][35][36] Two cohorts have similar ART duration as our study population but much lower prevalence of HTN: 19.3%…”

Exploring barriers and facilitators to integrated hypertension-HIV management in Ugandan HIV clinics using the Consolidated Framework for Implementation Research (CFIR)

“…Execution of HTN screening and treatment is generally suboptimal since it is at the discretion of the clinician especially at the lower performing HIV clinics. Suboptimal screening leads to low levels of awareness, treatment, retention and control of HTN among PLHIV [7][8][9][10][11][12]18].…”

Exploring barriers and facilitators to integrated hypertension-HIV management in Ugandan HIV clinics using the Consolidated Framework for Implementation Research (CFIR)

“…Persons living with HIV (PLHIV) and receiving antiretroviral therapy (ART) are at increased risk of cardiovascular disease (CVD) [1][2][3]. In Uganda, approximately 1/3 of PLHIV aged ≥18 years have hypertension (HTN), the leading cause of CVD and preventable mortality [4][5][6][7][8][9][10][11][12]. PLHIV with HTN have an increased risk of mortality compared to HIV negative persons [13].…”