Vascular dysfunction and body mass index in African adults with HIV

Abstract

Background Impaired vascular compliance is common among persons with HIV (PWH) and a risk factor for cardiovascular disease (CVD), though many studies documenting this are from regions with a high prevalence of overweight and obesity. The prevalence and characteristics of impaired vascular compliance among PWH with low body mass index (BMI) is not well described, particularly in sub-Saharan Africa (SSA) where the majority of PWH live, a low BMI is more common, and the burden of CVD is rising. Aim To assess non-invasive vascular compliance measurements, including augmentation index (AIX), pulse wave velocity (PWV) and pulse waveforms, in underweight, normal weight, and overweight PWH on long-term antiretroviral therapy (ART) in SSA. Methods A cross-sectional study among PWH on ART at the University Teaching Hospital in Lusaka, Zambia. All participants had been on a regimen of efavirenz, emtricitabine, and tenofovir disoproxil fumarate for five or more years. Carotid-femoral PWV (cfPWV), carotid-radial PWV (crPWV), and the corresponding augmentation indexes (cfAIX and crAIX), were measured in all participants, in addition to aortic pressure waveforms, classified as type A, B, C and D according to reflected wave timings and amplitude. Multiple linear regression assessed relationships between demographic and clinical factors with vascular measurement endpoints. Results Ninety one PWH on long-term ART were enrolled; 38 (42%) were underweight (BMI < 18.5 kg/m2), 43 (47%) were normal weight (18.5–24.9 kg/m2) and 10 (11%) were overweight (> 25 kg/m2). Median age was 41, 40 and 40 years, among the three groups, respectively, and the proportion of women increased with BMI level. Overweight participants had a 39% higher cfAIX compared to normal-weight participants, while being underweight was associated with 27% lower cfAIX, after adjusting for age, sex and blood pressure (P = 0.02 and P = 0.01, respectively), but measurements of cfPWV, crPWV and crAIX did not differ. Conclusion Underweight PWH in SSA had lower cfAIX measurements compared to normal weight individuals, indicating less arterial stiffness. However, similar cfPWV, crPWV and crAIX values among the underweight and overweight PWH suggest a low BMI may not confer substantial protection against impaired vascular compliance as a contributor to CVD risk among individuals on ART.

Dendritic cell epithelial sodium channel induced inflammation and salt-sensitive hypertension

“…HIV infection is a well studied immune system disorder. Vascular dysfunction and hypertension are common in people with HIV (PWH) and have been the focus of recent research [ 70 , 71 ]. While various factors contribute to cardiovascular disease in PWH, the relationship between HIV and salt sensitivity has emerged as an intriguing topic.…”

Epidemiology of obesity among people with HIV

“…In the Rakai Community Cohort Study in South-Central Uganda (63% female), obesity was also linked to increased odds of certain cardiovascular risk factors, such as hypertension (OR ¼ 2.31, 95% CI: 1.35-3.96) among PWH [33]. With respect to other cardiovascular risk factors, in a sub-Saharan African cohort, Kaluba et al showed that PWH who were overweight had impaired vascular function, assessed through the carotid femoral augmentation index, vs. normal-weight participants after controlling for factors such as sex, age, and blood pressure [34]. However, they also found that other indices of vascular compliance, such as carotid-femoral and carotid-radial pulse wave velocity, did not significantly differ between PWH who were underweight vs. overweight [34].…”

“…With respect to other cardiovascular risk factors, in a sub-Saharan African cohort, Kaluba et al showed that PWH who were overweight had impaired vascular function, assessed through the carotid femoral augmentation index, vs. normal-weight participants after controlling for factors such as sex, age, and blood pressure [34]. However, they also found that other indices of vascular compliance, such as carotid-femoral and carotid-radial pulse wave velocity, did not significantly differ between PWH who were underweight vs. overweight [34]. Additionally, using cross-sectional data from a US-based cohort (73% male and 44% Black), Buendia et al found that participants with overweight and obesity were at higher odds of having high total cholesterol or triglycerides (41% and 30%, respectively) [35].…”

“…Given the high prevalence of obesity among PWH on ART globally [2] and the myriad of metabolic complications associated with obesity [32,34,35], strong imperatives exist to better understand the factors contributing to and strategies to mitigate obesity risk among PWH. While ART is currently the standard of care for PWH [20], additional measures (pharmacologic and/or nonpharmacological) may need to be implemented at the time of ART initiation to prevent weight gain and/or treat prevalent obesity among PWH.…”