Subclinical atherosclerosis and associated risk factors among hiv-infected adults in Jos, North Central Nigeria: a cross-sectional study

Abstract

Introduction human immunodeficiency virus (HIV) is evolving into a leading cause of cardiovascular diseases (CVD) in sub-Saharan Africa (SSA) where the burden of HIV remains high. Atherosclerosis underlie progression to CVD. We therefore examined the prevalence of subclinical atherosclerosis and its association with traditional and non-traditional risk factors for CVD in Nigerian HIV-infected adults. Methods this was a cross-sectional study involving randomly selected stable HIV-infected patients with undetectable viral load attending HIV clinics at the Jos University Teaching Hospital and Faith Alive Foundation in Jos, Nigeria. Demographic data, biophysical measurements, cardiovascular risk factors and information regarding HIV-related factors, fasting serum lipid profile, fasting plasma glucose, high-sensitivity C-reactive protein and Carotid-Intima-Media-Thickness (CIMT) were assessed. Subclinical atherosclerosis was defined using a cut-off value of mean CIMT ≥ 0.78 mm. Data were analyzed with the Statistical Package for Social Sciences® (SPSS) software version 23.0 (IBM Corp., Chicago, Illinois, USA). Bivariate analysis and multivariate logistic regression were used to examine the association between risk factors of CVD and subclinical atherosclerosis. The statistical significance level was set at p ≤ 0.05. Results a total of 148 HIV adults (70.9% being females) on Anti-Retroviral Therapy (ART) were included in this study. The prevalence of subclinical atherosclerosis was 7.4%. Among subjects with subclinical atherosclerosis (SCA), 63.6% were males and 81.8% were hypertensive. Elevated blood glucose, lipids and high-sensitivity C-reactive protein, body mass index (BMI), HIV-related parameters (duration of HIV infection, antiretroviral regimen, CD4+ cell count), current smoking status, alcohol use, were not significantly associated with subclinical atherosclerosis (p>0.05). Male gender [OR(95%CI=4.91(1.36-17.77)], age [OR(95%CI)=1.14(1.06-1.23)], hypertension [OR(95%CI=14.4(3.03-71.86)] and metabolic syndrome [OR(95%CI=8.34(1.73-40.18)] were significantly associated with SCA at bivariate analysis. After adjusting for age, sex and antiretroviral regimen, only increasing age [Adjusted Odds Ratio (AOR) (95% confidence interval (CI)] = 1.12(1.01-1.25)] and hypertension [AOR (95%CI)=10.67 (1.31-87.18)], remained as independent predictors of subclinical atherosclerosis (SCA). Conclusion the prevalence of subclinical atherosclerosis among HIV-infected adults is high in Nigeria. It is significantly associated with increasing age and hypertension. Traditional CVD risk factors such as dyslipidaemia, diabetes mellitus and obesity were not associated with subclinical atherosclerosis in this population.

Carotid Ultrasound Abnormalities of People Living With HIV in Kunming, China: Multiple Correspondence Analysis Approach to Identify Influencing Factors

“…The risk of carotid artery anomalies in PLWH may also increase with the increased occurrence of SCA. Imoh et al 10 supported the idea that age is a risk factor for developing SCA in PLWH, suggesting that hypertension is an independent predictor of SCA. Additionally, hypertension prevalence in PLWH may be associated with age [34][35][36][37] and may also be related to BMI, 36,37 HIV viral load, 35 ART use, 34 and ART regimen.…”

“…There are fewer studies about age and carotid ultrasound abnormalities. Imoh et al 10 found that, as in the general population, age remains an essential factor in the event of SCA in PLWH. The risk of carotid artery anomalies in PLWH may also increase with the increased occurrence of SCA, older patients at higher risk of SCA when viral load is uncontrolled.…”

“…7 Considering that the increased SCA risk in PLWH is due to a combination of factors, a previously published case-control study showed that the effect of HIV-positivity and ART treatment on SCA becomes more prominent with age. 8 In addition to age, 9,10 the effects of low CD4 + T lymphocytes, 9 hypertension, 10 and serum lipid disorders 11 on SCA are worth noticing. Serrano-Villar et al 12 compared the value of the Framingham, SCORE, and D:A:D equations in identifying SCA in PLWH.…”