Age-related differences in the vascular function and structure of South Africans living with HIV

Anisca Louwrens,Yolandi Breet,Carla M.T Fourie,Shani Botha-Le Roux

doi:10.4102/sajhivmed.23i1.1335

Anisca Louwrens, Yolandi Breet + Show 2 more

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https://doi.org/10.4102/sajhivmed.23i1.1335

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Abstract

BackgroundAs the life expectancy of people living with the HIV increases because of antiretroviral treatment (ART), their risk for vascular co-morbidities and early vascular ageing (EVA) also increases.ObjectiveWe aimed to investigate whether HIV infection relates to vascular structure and function in black South African adults and whether this relationship is age dependent.MethodThis cross-sectional study carried out in urban and rural areas of North West province, South Africa, included 572 age- and sex-matched people living with HIV (PLWH) and without HIV. Participants from the EndoAfrica study and PURE study were stratified according to tertiles of age. Measures of vascular structure (carotid intima-media thickness) and function (carotid-femoral pulse wave velocity, central systolic blood pressure, central pulse pressure and pulse pressure amplification) were determined.ResultsBlood pressure measures were lower in PLWH compared with their controls (all P ≤ 0.001), especially in the younger and middle-aged groups (all P ≤ 0.031), whilst vascular measures did not differ (all P ≥ 0.611). In multivariate linear regression analyses, vascular measures were not associated with a HIV- positive status in either the total or any of the age groups.ConclusionBlack South Africans living with HIV have a less adverse blood pressure profile than their counterparts without HIV. The HIV-positive status was not associated with measures of vascular structure or function in any age group. The results suggest that HIV does not contribute to EVA in this population; however, further longitudinal investigation is warranted.

Highlights

The HIV epidemic is a global health problem with South Africa contributing a large number of people living with HIV (PLWH); of the 38 million PLWH worldwide, 7.7 million reside in South Africa.[1]
People living with HIV had a lower waist-to-height ratio (WtHR) and Body mass index (BMI) compared with the HIV-free group
With regard to cardiovascular measurements, all brachial blood pressures were lower in PLWH; no differences were found in either carotidfemoral pulse wave velocity (cfPWV), carotid intima-media thickness (cIMT) or pressure amplification (PPA)

Summary

Introduction

The HIV epidemic is a global health problem with South Africa contributing a large number of people living with HIV (PLWH); of the 38 million PLWH worldwide, 7.7 million reside in South Africa.[1]. Physiological, vascular ageing occurs with the progression of age and is a gradual and continuous process, characterised by structural and/or mechanical changes within the vessel wall.[8,9] These mechanical and structural alterations that occur with vascular ageing may result in arterial stiffness and an increased carotid intima-media thickness (cIMT),[10] which can affect some individuals prematurely, a term coined early vascular ageing (EVA).[11]. Diabetes mellitus[18] and dysglycaemia,[19] as well as factors related to an unhealthy lifestyle,[20,21,22] lead to acceleration of the vascular ageing process.[23]. Vascular comorbidities, such as arterial stiffness and atherosclerosis,[5,6] as well as cardiometabolic disturbances,[24,25] become increasingly evident with the prolonged life expectancy of PLWH because of the effectiveness of antiretroviral treatment (ART).[26] http://www.sajhivmed.org.za. As the life expectancy of people living with the HIV increases because of antiretroviral treatment (ART), their risk for vascular co-morbidities and early vascular ageing (EVA) increases

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