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

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

doi:10.4102/sajhivmed.v23i1.1335

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https://doi.org/10.4102/sajhivmed.v23i1.1335

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Abstract

Background: 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) also increases.Objective: We aimed to investigate whether HIV infection relates to vascular structure and function in black South African adults and whether this relationship is age dependent.Method: This 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.Results: Blood 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.Conclusion: Black 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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