Effect of cardio-metabolic risk factors on all-cause mortality among HIV patients on antiretroviral therapy in Malawi: A prospective cohort study

Amberbir, Alemayehu; Banda, Victor; Singano, Victor; Matengeni, Alfred; Pfaff, Colin; Ismail, Zahra; Allain, Theresa J.; Chan, Adrienne K.; Sodhi, Sumeet; Oosterhout, Joep J. van

doi:10.1371/journal.pone.0210629

Cited by 14 publications

(16 citation statements)

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“…This finding has important implication as elevated TC/ HDL-c ratio may increase the risk of CVD [ 21 ]. A high TG/HDL-C ratio present in 3.7% of the patients on ART at a rural and an urban HIV clinic in Zomba district, Malawi was associated with all-cause mortality [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…Dyslipidaemia associated with combination ART use is characterized by increased levels of serum total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c) and triglycerides (TG) and a decreased high density lipoprotein-cholesterol (HDL-c) level [ 3 , 5 , 6 ]. These changes in lipid level occur early after the initiation of combined ART, and have been associated with an increased risk for cardiovascular disease and mortality [ 7 – 9 ]. In patients receiving combination ART, changes in lipid profiles have been also shown to be an independent risk factor for adverse outcomes, including cardiovascular-related events, reduced life expectancy and increased use of medical resources, which can greatly increase healthcare costs of the disease and reduce quality of life of patients with HIV [ 8 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

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Prevalence of dyslipidaemia among HIV-infected patients receiving combination antiretroviral therapy in North Shewa, Ethiopia

et al. 2021

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Background Data on the burden of dyslipidaemia among people with HIV undergoing antiretroviral therapy (ART) in sub-Saharan Africa are limited and little is known about the factors contributing for poor lipid profiles. The aim of this study was to determine the prevalence of dyslipidaemia and factors associated with lipid levels among HIV-infected patients receiving first-line combination ART in North Shewa, Ethiopia. Methods A cross-sectional study was conducted between April and December 2018 among 392 HIV-infected adults receiving first-line ART for at least six months at the ART clinic of Mehal Meda Hospital in North Shewa, Ethiopia. Blood samples were collected for determination of total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), and CD4 counts. Logistic regression analysis was used to determine factors associated with lipid abnormalities. Results The prevalence of dyslipidaemia was 59.9% (95% CI 55.0–64.7%). High TC, high TG, low HDL-c, and high LDL-c were obtained in 47.3%, 30.9%, 19.4% and 29.6%, respectively. Fifty-four participants (13.8%) had high ratio of TC/HDL-c (TC/HDL-c ratio ≥ 5). Older age was independently associated with high TC (AOR = 2.51, 95% CI 1.64–3.84), high TG (AOR = 2.95, 95% CI 1.85–4.71), low HDL–c (AOR = 2.02, 95% CI 1.17–3.50), and high LDL–c (AOR = 3.37, 95% CI 2.08–5.47). Living in an urban area (AOR = 2.61, 95% CI 1.16–6.14) and smoking (AOR = 3.61, 95% CI 1.06–12.34) were associated with low HDL–c. Participants with longer duration of ART use were more likely to have high TG (AOR = 1.86, 95% CI: 1.13–3.07), low HDL–c (AOR = 3.47, 95% CI: 1.75–6.80), and high LDL–c (AOR = 2.20, 95% CI 1.30–3.71). High BMI was independently associated with higher TC (AOR = 2.43, 95% CI 1.19–4.97), high TG (AOR = 4.17, 95% CI 2.01–8.67) and high LDL–c (AOR = 6.53, 95% CI 3.05–13.98). Conclusions We found a high prevalence of dyslipidaemia among HIV-infected patients receiving first-line ART in North Shewa, Ethiopia. There is a need for monitoring of blood lipid levels in patients with HIV on long term first-line ART with a special attention to be focused on older age, urban residents, longer duration of ART use, high BMI and smokers.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prevalence of dyslipidaemia among HIV-infected patients receiving combination antiretroviral therapy in North Shewa, Ethiopia

et al. 2021

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“…Chronic inflammation persists in people living with HIV (PLWH) despite long-term suppressive antiretroviral therapy (ART), contributing to vascular dysfunction and non-communicable diseases [1][2][3]. Low income sub-Saharan Africa (SSA) faces an epidemiological transition in cardiovascular disease (CVD), as urbanisation increases traditional cardiovascular risk factors [4,5]. Hypertension is already highly prevalent; diabetes, dyslipidaemia and obesity are increasing [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Inflammatory Phenotypes Predict Changes in Arterial Stiffness Following Antiretroviral Therapy Initiation

Kelly

Tinago

Alber

et al. 2020

Clinical Infectious Diseases

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Background Inflammation drives vascular dysfunction in HIV, but in low-income settings causes of inflammation are multiple, and include infectious and environmental factors. We hypothesised that patients with advanced immunosuppression could be stratified into inflammatory phenotypes that predicted changes in vascular dysfunction on ART. Methods We recruited Malawian adults with CD4<100 cells/ul two weeks after starting ART in the REALITY trial (NCT01825031). Carotid femoral pulse wave velocity (cfPWV) measured arterial stiffness 2, 12, 24 and 42 weeks post-ART initiation. Plasma inflammation markers were measured by electrochemiluminescence at weeks 2 and 42. Hierarchical clustering on principal components identified inflammatory clusters. Results 211 HIV-positive participants grouped into three clusters of inflammatory marker profiles representing 51 (24%) (cluster-1), 153 (73%) (cluster-2) and 7 (3%) (cluster-3) individuals. Cluster-1 showed markedly higher CD4 and CD8 T-cell expression of HLADR and PD1 vs cluster-2 and cluster-3 (all p<0.0001). Although small, individuals in cluster-3 had significantly higher levels of cytokines reflecting inflammation (IL6, IFNɣ, IP10, IL1RA, IL10), chemotaxis (IL8), systemic and vascular inflammation (CRP, ICAM1, VCAM1) and SAA (all p<0.001). In mixed-effects models, cfPWV changes over time were similar for cluster-2 vs cluster-1 (relative-fold-change 0.99 (95% CI 0.86-1.14, p=0.91, but greater in cluster-3 vs cluster-1 (relative-fold-change 1.45 (95% CI 1.01-2.09, p=0.045). Conclusions Two inflammatory clusters were identified: one defined by high T-cell PD1 expression and another by a hyper-inflamed profile and increases in cfPWV on ART. Further clinical characterisation of these inflammatory phenotypes could help target vascular dysfunction interventions to those at highest risk.

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“…While there are few studies conducted on cardiometabolic risk factors among migrants [19], adult population [20,21] and people living with HIV [22] in Nepal and other developing countries, we could not find any studies on TB patients. The consequence of diabetes, hypertension as well as other cardiometabolic risk factors among patients with TB is under-appreciated.…”

Section: Introductionmentioning

confidence: 73%

Cardiometabolic risk factors among patients with tuberculosis attending tuberculosis treatment centers in Nepal

et al. 2020

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Background: The co-morbidity of cardiometabolic diseases in patients with Tuberculosis adds a significant burden in current health systems in developing countries including Nepal. The main objective of this study was to explore cardiometabolic risk factors among patients with Tuberculosis. Methods: This was a cross-sectional study conducted among patients with tuberculosis in 12 tuberculosis treatment centers from eight districts of Nepal between May and July 2017. Interviews with participants were conducted using a structured questionnaire and were supplemented by anthropometric measurements and on-site blood glucose tests. Data were analyzed using descriptive and inferential statistics. Results: Among 221 study participants, 138 (62.4%) had new smear-positive pulmonary tuberculosis, 24 (10.9%) had new smear-negative pulmonary tuberculosis and 34 (15.4%) had new extra-pulmonary tuberculosis. Overall, 43.1% of the patients with tuberculosis had at least one cardiometabolic risk factor. The prevalence of at least one cardiometabolic risk factor was more in male than female (47.8% versus 33.8%). Prevalence of tobacco (18.9% versus 4.8%), and alcohol (12.6% versus 6.5%) use was proportionately higher in male compared to female. The prevalence of hypertension (17% vs. 21%) and obesity (11.9% vs. 12.9%) was lower in male compared to females. Female (AOR = 0.47; CI: 0.23-0.94), those from Gandaki Province (AOR = 0.32; CI: 0.13-0.79) and literate (AOR = 0.49; CI: 0.25-0.96) had reduced risk of cardiometabolic disease risk factors. Conclusions: This study highlights the role of gender and socio-demographic characteristics associated with the risk of cardiometabolic diseases in patients with Tuberculosis. The findings from this study can guide medical practitioners and policy makers to consider clinical suspicion, diagnosis and treatment. National treatment guideline can benefit by integrating the management of non-communicable diseases in Tuberculosis treatment centers.

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Effect of cardio-metabolic risk factors on all-cause mortality among HIV patients on antiretroviral therapy in Malawi: A prospective cohort study

Cited by 14 publications

References 21 publications

Prevalence of dyslipidaemia among HIV-infected patients receiving combination antiretroviral therapy in North Shewa, Ethiopia

Prevalence of dyslipidaemia among HIV-infected patients receiving combination antiretroviral therapy in North Shewa, Ethiopia

Inflammatory Phenotypes Predict Changes in Arterial Stiffness Following Antiretroviral Therapy Initiation

Cardiometabolic risk factors among patients with tuberculosis attending tuberculosis treatment centers in Nepal

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