Risk factors and assessment for cardiovascular disease among HIV-positive patients attending a Nigerian tertiary hospital

Abstract

IntroductionCardiovascular risk factors are prevalent in HIV-positive patients which places them at increased risk for cardiovascular disease (CVD). We aimed to determine the risk factors and risk assessment for CVD in HIV-positive patients with and without antiretroviral therapy.MethodsThis was a cross-sectional study of HIV-positive patients attending the Lagos University Teaching Hospital, Nigeria. Anthropometric and blood pressure measurements were performed; fasting lipid profile, plasma glucose, homocysteine and hsCRP were determined, as well as prevalences and risk assessments. Statistical tests were used to compare the groups and p-value <0.05 was considered to be significant.Results283 subjects were recruited for this study (100 HIV-positive treatment-naive, 100 HIV-positive treated and 83 HIV negative controls). Compared to the controls, mean (sd) values were significantly higher among HIV-treated subjects: waist circumference = 88.7 (10.4), p = 0.035; systolic bp= 124.9 (20.7), p = 0.014; glucose= 5.54 (1.7), p = 0.015; triglyceride= 2.0 (1.2), p < 0.001; homocysteine= 10.9 (8.9-16.2), p = 0.0003; while hsCRP= 2.9 (1.4-11.6), p = 0.002 and HDL-C = 0.9 (0.4), p = < 0.0001 were higher among the HIV-naïve subjects. Likewise, higher prevalences of the risk factors were noted among the HIV-treated subjects except low HDL-C (p < 0.001) and hsCRP (p = 0.03) which were higher in the HIV-naïve group. Risk assessment using ratios showed high risk for CVD especially in the HIV-naïve group. The median range for Framingham risk assessment was 1.0 - 7.5%.ConclusionRisk factors and risk assessment for CVD are increased in HIV-positive patients with and without antiretroviral therapy. Routine evaluation and risk assessment for CVD irrespective of therapy status is necessary to prevent future cardiovascular events.

The association between antiretroviral therapy and selected cardiovascular disease risk factors in sub-Saharan Africa: A systematic review and meta-analysis

“…Eight studies reported on DM [ 22 – 24 , 27 – 30 , 33 ], and 3 of these studies found statistically higher odds of DM in patients on ART ( Table 3 & Fig 3 ) [ 27 , 29 , 33 ]. Overall, there was no statistically significant association between DM and ART use (Pooled estimate: 2.53, 95% CI: 0.87–7.35, p = 0.089), and a significant between-study heterogeneity (p<0.001, I 2 statistic = 70.7%).…”

“…All 8 studies that reported on total cholesterol found higher odds of having a high TC level in patients receiving ART compared to ART-naïve patients [ 18 , 23 , 25 , 28 , 30 , 33 – 35 ]. The overall pooled estimate was 3.85 (95% CI: 2.45–6.07, p<0.001), the between study heterogeneity p = 0.003 and I 2 statistic = 67.0%.…”

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

“…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].…”

Prevalence of Human Cytomegalovirus Infection among Human Immunodeficiency Virus Positive Women Receiving Antiretroviral Treatment at Federal Teaching Hospital Abakaliki, Ebonyi State, Nigeria

“…Risk factors and risk assessment for cardiovascular diseases are increased in HIV-positive patients with and without antiretroviral therapy. These factors include hypertension, measures of obesity, diabetes mellitus, dyslipidaemia, and homocysteine [26]. Electrocardiography is effectively used to detect cardiac Diseases.…”