HIV treatment is associated with a twofold higher probability of raised triglycerides: pooled analyses in 21 023 individuals in sub-Saharan Africa

Ekoru, Kenneth; Young, Elizabeth H.; Dillon, David; Gurdasani, Deepti; Stehouwer, Nathan; Faurholt‐Jepsen, Daniel; Levitt, Naomi; Crowther, Nigel J.; Nyirenda, Moffat; Njelekela, Marina; Ramaiya, Kaushik; Nyan, Ousman; Adewole, Olanisun Olufemi; Anastos, Kathryn; Compostella, Caterina; Dave, Joel A.; Fourie, C.M.T.; Friis, Henrik; Kruger, Iolanthé M.; Longenecker, Chris T.; Maher, Dermot; Mutimura, Eugene; Ndhlovu, Chiratidzo E.; PrayGod, George; Yone, Eric Walter Pefura; Pujades-Rodríguez, Mar; Range, Nyagosya; Sani, Mahmoud U; Muhammad, Sanusi; Schutte, Aletta E.; Sliwa, Karen; Tien, Phyllis C.; Vorster, Este H; Walsh, Corinna M.; Gareta, Dickman; Mashili, Fredirick; Sobngwi, Eugène; Adebamowo, Clement; Kamali, Anatoli; Seeley, Janet; Smeeth, Liam; Pillay, Deenan; Motala, Ayesha A.; Kaleebu, Pontiano; Sandhu, Manjinder S.

doi:10.1017/gheg.2018.7

Cited by 14 publications

(9 citation statements)

References 44 publications

(45 reference statements)

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“…However, ART is now initiated most often in people living in sub Saharan Africa, where data defining the metabolic effects of treatment are scarce. In a 2018 meta analysis of 14 trials and including a total of 21,023 individuals from this region, ART was associated with an increased risk of hypertriglyceri daemia (RR 2.05, 95% CI 1.51-2.77); however, no con sistent associations were observed between ART and raised blood pressure, blood glucose levels, glycated haemoglobin (HbA 1c ) levels or other blood lipids 135 .…”

Section: Management Of Cvd Risk In Hiv Infectionmentioning

confidence: 99%

HIV infection and coronary heart disease: mechanisms and management

2019

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Section: Management Of Cvd Risk In Hiv Infectionmentioning

confidence: 99%

HIV infection and coronary heart disease: mechanisms and management

2019

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“…In a recent meta-analysis of 14 trials of 21,023 individuals assessed between 2003 and 2014 from this region, ART was associated with an increased risk of hypertriglyceridemia (relative risk, 2.05; 95% confidence interval [CI], 1.51-2.77). 26 The associations between ART and raised blood pressure, glucose, hemoglobin A1c, and other lipids were inconsistent across studies.…”

Section: Lipid Abnormalitiesmentioning

confidence: 99%

“…The antioxidative properties of HDL-C are also impaired because of a loss of antioxidant proteins and accumulation of oxidized phospholipids. 26 Macrophage myeloperoxidase, which is induced by inflammatory stimuli in atherosclerotic plaques, also mediates reductions in HDL-C function via oxidation. Table 1 for specific names of antiretroviral therapy drugs.…”

Section: Interaction Between Inflammation and Lipoproteins In Hivmentioning

confidence: 99%

Lipid Abnormalities in Persons Living With HIV Infection

Waters

Hsue

2019

Canadian Journal of Cardiology

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Lipid abnormalities are prevalent among persons living with HIV infection and contribute to increasing the risk of cardiovascular events. Antiretroviral therapy (ART) is associated with lipid abnormalities, most commonly hypertriglyceridemia, but also increases in low-density lipoprotein cholesterol and total cholesterol. Different classes of ART, and different drugs within classes, have differing effects on lipid levels, but in general newer drugs have more favourable effects compared with older ones. Low-level inflammation and chronic immune activation act on lipids through a variety of mechanisms to make them more atherogenic. As a consequence, risk is higher than would be expected for any given cholesterol level. Clinical outcome trials of cholesterollowering therapies have not yet been completed in people living with HIV, so that treatment decisions depend on extrapolation from studies in uninfected populations. Traditional risk assessment tools underestimate cardiovascular risk in individuals with HIV. Statins are the mainstay of lipid-lowering drug treatment; however, drugedrug interactions with ART must be considered.

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“…The prevalence of hypertension in PLHIV is estimated to range from 9 to 46% in low-and middle-income countries (LMICs) [13,14], similar to high-income countries [15][16][17]. Patients on ART are more likely to have dysglycemia, hypertriglyceridemia, and lower levels of high-density lipoprotein cholesterol [18][19][20], which may increase hypertension risk. Also relevant, studies indicate that HIV may increase the risk of non-communicable disease (NCD), including cardiovascular disease CVD, due to stimulation of inflammatory markers and adverse events of ART [21][22][23][24].…”

Section: Introductionmentioning

confidence: 99%

Systems analysis and improvement approach to optimize the hypertension diagnosis and care cascade for PLHIV individuals (SAIA-HTN): a hybrid type III cluster randomized trial

et al. 2020

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Background: Across sub-Saharan Africa, evidence-based clinical guidelines to screen and manage hypertension exist; however, country level application is low due to lack of service readiness, uneven health worker motivation, weak accountability of health worker performance, and poor integration of hypertension screening and management with chronic care services. The systems analysis and improvement approach (SAIA) is an evidence-based implementation strategy that combines systems engineering tools into a five-step, facility-level package to improve understanding of gaps (cascade analysis), guide identification and prioritization of low-cost workflow modifications (process mapping), and iteratively test and redesign these modifications (continuous quality improvement). As hypertension screening and management are integrated into chronic care services in sub-Saharan Africa, an opportunity exists to test whether SAIA interventions shown to be effective in improving efficiency and coverage of HIV services can be effective when applied to the non-communicable disease services that leverage the same platform. We hypothesize that SAIA-hypertension (SAIA-HTN) will be effective as an adaptable, scalable model for broad implementation. Methods: We will deploy a hybrid type III cluster randomized trial to evaluate the impact of SAIA-HTN on hypertension management in eight intervention and eight control facilities in central Mozambique. Effectiveness outcomes include hypertension cascade flow measures (screening, diagnosis, management, control), as well as hypertension and HIV clinical outcomes among people living with HIV. Cost-effectiveness will be estimated as the incremental costs per additional patient passing through the hypertension cascade steps and the cost per additional disability-adjusted life year averted, from the payer perspective (Ministry of Health). SAIA-HTN implementation fidelity will be measured, and the Consolidated Framework for Implementation Research will guide qualitative evaluation of the implementation process in high-and low-performing facilities to identify determinants of intervention success and failure, and define core and adaptable components of the SAIA-HTN intervention. The Organizational Readiness for Implementing Change scale will measure facility-level readiness for adopting SAIA-HTN.

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HIV treatment is associated with a twofold higher probability of raised triglycerides: pooled analyses in 21 023 individuals in sub-Saharan Africa

Cited by 14 publications

References 44 publications

HIV infection and coronary heart disease: mechanisms and management

HIV infection and coronary heart disease: mechanisms and management

Lipid Abnormalities in Persons Living With HIV Infection

Systems analysis and improvement approach to optimize the hypertension diagnosis and care cascade for PLHIV individuals (SAIA-HTN): a hybrid type III cluster randomized trial

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