Objectively measured physical activity among people with and without HIV in Uganda: associations with cardiovascular risk and coronary artery disease

Abstract

BackgroundAfrica has a disproportionate burden of HIV-related cardiovascular disease. We aimed to describe physical activity in people living with HIV (PLHIV) and people without HIV (PWOH) in Uganda and characterize its relationship with the presence of computed tomography angiography-detected (CCTA) coronary artery disease (CAD).MethodsWe performed a cross-sectional analysis of the Ugandan Study of HIV Effects on the Myocardium and Atherosclerosis using Computed Tomography (mUTIMA-CT) cohort. From 2017-2019, physical activity in PLHIV and PWOH was assessed by accelerometry over seven days. Participants additionally underwent CCTA. Univariable and multivariable modified Poisson regression was used to analyze the relationship between physical activity and CAD presence.Results168 participants were analyzed. The median (IQR) age was 57 (53-58) years old and 64% were female. Males had more moderate-to-vigorous physical activity per week [68 minutes (12-144) vs 15 minutes (0-50),P<0.001] and less light physical activity [788 minutes (497-1,202) vs [1,059 (730-1490),P=0.001] compared to females, but there was no difference by HIV status. After adjusting for age, which accounted for 10% of the variation in steps taken, and sex, no significant associations were found between physical activity and coronary plaque.ConclusionObjectively measured physical activity was low compared to guideline recommendations, with males being somewhat more active than females and without significant differences by HIV status. Physical activity was not associated with the presence of CAD independently of age and sex.CLINICAL PERSPECTIVEWhat is new?For the first time, we describe objective physical activity patterns in people living with HIV (PLHIV) and people without HIV (PWOH) in the Ugandan context. Overall, few people met guideline recommendations for physical activity. Males had more moderate-to-vigorous physical activity and were more likely to meet guideline recommendations compared to females, without significant difference by HIV status.In contrast, females had more light physical activity compared to males. Although light physical activity appeared to have a stronger inverse relationship with coronary artery disease (CAD) in PLHIV compared to PWOH in stratified models, the relationship was significantly confounded by age and sex.What are the clinical implications?Larger studies are needed to further investigate the relationship between physical activity and CAD in Africa—including any modifying influence of sex or HIV status. In the meantime, our study suggests there is significant room to enhance physical activity in Uganda.Age informs the relationship between physical activity and CAD, and our study suggests efforts to emphasize exercise as the population ages may play a role in reducing CAD burden.