Abstract 11289: Sedentary Time in Uganda: Influence of Sex and HIV Status and Associations with Atherosclerotic Cardiovascular Disease Risk

Abstract

Introduction: Sub-Saharan Africa (SSA) is disproportionately impacted by HIV and HIV-related atherosclerotic cardiovascular disease (ASCVD). Since physical activity may prevent ASCVD events, it is important to understand how physical activity and inactivity relate to ASCVD risk among men and women with and without HIV in SSA. Methods: One hundred people with HIV (PWH) and 100 people without HIV (PWOH) matched by age and sex were enrolled into this observational study in Kampala, Uganda. Physical activity was objectively measured by actigraphy for 7 days, including steps per day, light activity time, moderate-to-vigorous activity time and sedentary time. ASCVD risk was assessed using the pooled-cohort equations. Coronary artery disease was quantified by cardiac computed tomography angiography. Multivariable linear and logistic regression models were used to determine the relationship between physical activity, ASCVD risk, and subclinical coronary disease. Results: Median age was 57 years; 63% were female and median ASCVD risk score was 7.9%. All PWH were on antiretroviral therapy and 86% had undetectable HIV viral load. Physical activity patterns were similar by HIV status (all p>0.2). Compared to males, females took more steps per day ( p =0.001) and engaged in more light activity time ( p <0.001), but less moderate-to-vigorous activity time ( p <0.001). Sedentary time was similar by HIV status and sex (both p>0.8). After adjusting for moderate-to-vigorous activity time, sedentary time remained positively associated with ASCVD risk (standardized β=0.334, p <0.001). In stratified models, sedentary time was associated with ASCVD risk in females (β=0.258, p =0.028) but not males (p=0.194) and in PWOH (β=0.430, p=0.001) but not PWH (p=0.380). Sedentary time was associated with the presence of coronary artery disease plaque, even after adjustment for ASCVD risk score (adjusted OR= 1.039 per hour of sedentary time, p =0.018). Conclusions: Sedentary time is strongly associated with atherosclerotic cardiovascular disease risk in Uganda, particularly among females, but less so among PWH. Future studies should consider the influence of sex and HIV status while developing targeted strategies to improve physical activity and reduce sedentary time.