Endothelial activation and cardiometabolic profiles of treated and never-treated HIV infected Africans

Fourie, C.M.T.; Schutte, Aletta E.; Smith, Wayne; Kruger, Annamarie; Rooyen, Johannes M. Van

doi:10.1016/j.atherosclerosis.2015.03.015

Cited by 63 publications

(71 citation statements)

References 46 publications

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“…33 In contrast, a recent study comparing carotid intima media thickness measurements between PLWH and HIV uninfected controls found no difference between groups, although the uninfected population was slightly older and a higher proportion were male. 34 Nevertheless, another recent study noted strong associations between persistent immune activation after ART and carotid atherosclerosis among HIV-infected persons in Uganda, suggesting a role of HIV-associated inflammation in increasing CVD risk in this population. 35 As outcome data begin to accrue, important questions for the field include whether the increased risk of CVD seen in relatively young people with HIV in sub-Saharan Africa will translate into CVD morbidity and mortality, and whether current risk scores accurately predict risk in this population.…”

Section: Discussionmentioning

confidence: 95%

High Prevalence of Metabolic Syndrome and Cardiovascular Disease Risk Among People with HIV on Stable ART in Southwestern Uganda

Muyanja

Muzoora

Muyingo

et al. 2016

AIDS Patient Care and STDs

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The objectives of this study were to determine the epidemiology and correlates of cardiovascular disease (CVD) risk among Ugandans on first-line antiretroviral therapy (ART). We conducted a cross-sectional study at an HIV clinic in southwestern Uganda. We enrolled adult patients on non-nucleoside-based ART regimens for a minimum of 2 years. We collected anthropometric and clinical measurements, smoking history, and blood for fasting lipid profile and blood sugar (FBS). Outcomes of interest were (1) presence of metabolic syndrome (at least two of the following: FBS >100 mg/dL, blood pressure of ≥130/85 mmHg, triglycerides ≥150 mg/dL, HDL <40 mg/DL, or waist circumference ≥94 cm in males or ≥80 cm in females); and (2) a Framingham score correlating to >5% 10-year CVD risk. Of the 250 participants enrolled, metabolic syndrome was detected in 145/250 (58%) of participants (62% in females and 50% in males). Forty-three participants (17%) had a Framingham risk correlating to a 5% or greater risk for CVD within 10 years (26% in males and 13% in females). In multivariate analyses, being female (AOR 3.13; 95% CI: 1.0-9.70; p = 0.04) and over 40 years of age (AOR 1.78; 95% CI: 1.00-3.17; p = 0.05) was independently associated with having metabolic syndrome. We found no independent risk factors for a Framingham risk score 10-year risk exceeding 5%, or associations between ART regimen and CVD risk profiles. We conclude that metabolic abnormalities are common among patients on first-line ART in rural Uganda, and appear to be more common in women than men.

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Section: Discussionmentioning

confidence: 95%

High Prevalence of Metabolic Syndrome and Cardiovascular Disease Risk Among People with HIV on Stable ART in Southwestern Uganda

Muyanja

Muzoora

Muyingo

et al. 2016

AIDS Patient Care and STDs

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“…This suggests that the mechanism by which low pre-ART CD4 is associated with hypertension may not be mediated by chronic immune activation 42,43 . Whereas further data will be required to help elucidate these mechanisms, it could be explained by the possibility that immunodeficiency and immune activation affect hypertension risk through fundamentally distinct pathways 14,44,45 .…”

Section: Discussionmentioning

confidence: 99%

D-Dimer Levels and Traditional Risk Factors Are Associated With Incident Hypertension Among HIV-Infected Individuals Initiating Antiretroviral Therapy in Uganda

Okello

Asiimwe

Kanyesigye

et al. 2016

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Objectives We sought to describe blood pressure changes after antiretroviral therapy (ART) initiation and evaluate the association of markers of inflammation with incident hypertension in a cohort of HIV-individuals in Uganda. Methods We used mixed effects linear regression to model changes in systolic blood pressure (BP) over time among a cohort of HIV-infected individuals initiating ART in Uganda. After exclusion of participants with pre-existing hypertension, we identified participants with normal BP throughout follow-up (controls) and those with elevated BP on ≥3 consecutive visits (cases). Prior to ART initiation, participants had testing for lnterleukin-6, kynurenine/tryptophan ratio, lipopolysaccharide, soluble CD14, soluble CD163, and D-dimer and those with viral suppression at six months during ART had repeat tests. We fit logistic regression models to estimate associations between biomarkers and risk of incident hypertension. Results In the entire cohort, systolic BP increased by 9.6 mmHg/year (95% CI 7.3 - 11.8) in the first six months of ART, then plateaued. Traditional factors: male gender (AOR 2.76, 95% CI 1.34-5.68), age (AOR 1.09, 95% CI 1.04-1.13), overweight (AOR 4.48, 95%CI 1.83-10.97), and a CD4 count < 100 cells (AOR 3.08, 95% CI 1.07-8.89) were associated with incident hypertension. After adjusting for these, D-dimer levels at month 6 were inversely associated with incident hypertension (AOR 0.61, 95% CI 0.37-0.99). Although not significant, similar associations were seen with sCD14 and Kynurenine/Tryptophan (K/T) ratio. Conclusion Blood pressure increases early after ART initiation in Ugandans. Traditional risk factors, rather than immune activation were associated with incident hypertension in this population.

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“…In high-income countries, HIV infection is associated with increased prevalence of arterial stiffness [4–6], an important predictor of decreased quality of life, cardiovascular complications and mortality [7–10]. Although some preliminary data suggest that HIV infection might predispose to cardiovascular disease risk in sub-Saharan Africa [11–14], little is known about relationships between HIV infection and arterial stiffness in the region, where differences in genetics, higher rates of parasitic and other co-infections, and altered diet, smoking and physical activity are likely to impact the priority disease states. In this study, we assessed whether HIV infection is associated with arterial stiffness among people on stable ART in rural Uganda.…”

Section: Introductionmentioning

confidence: 99%

HIV infection and arterial stiffness among older-adults taking antiretroviral therapy in rural Uganda

Siedner

Kim

Nakku

et al. 2016

Aids

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HIV infection is associated with arterial stiffness, but no studies have assessed this relationship in sub-Saharan Africa. We enrolled 205 participants over 40 years old in Uganda: 105 on antiretroviral therapy for a median of 7 years, and a random sample of 100 age and gender-matched HIV-uninfected controls from the clinic catchment area. The prevalence of arterial stiffness (ABI>1.2) was 33%, 18%, 19% and 2% in HIV+ men, HIV- men, HIV+ women, and HIV- women. In multivariable models adjusted for cardiovascular risk factors, HIV+ individuals had over double the prevalence of arterial stiffness (APR 2.86, 95%CI 1.41–5.79, P=0.003).

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Endothelial activation and cardiometabolic profiles of treated and never-treated HIV infected Africans

Cited by 63 publications

References 46 publications

High Prevalence of Metabolic Syndrome and Cardiovascular Disease Risk Among People with HIV on Stable ART in Southwestern Uganda

High Prevalence of Metabolic Syndrome and Cardiovascular Disease Risk Among People with HIV on Stable ART in Southwestern Uganda

D-Dimer Levels and Traditional Risk Factors Are Associated With Incident Hypertension Among HIV-Infected Individuals Initiating Antiretroviral Therapy in Uganda

HIV infection and arterial stiffness among older-adults taking antiretroviral therapy in rural Uganda

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