Abstract
HIV/AIDS is an increasingly important cause of cardiovascular (CVD) morbidity world-wide. We sought to evaluate the prevalence of CVD risk factors in HIV positive (HIV+) adults and assessment of these risks using the Framingham risk score (FRS). A cross-sectional study of adult clients of the HIV clinic at Jos University Teaching Hospital. One hundred and fifty HIV+ selected randomly with 50 (age and sex matched) HIV negative (HIV-) participants were enrolled. Relevant history, physical examination and biochemical investigations and 12-lead electrocardiography were performed. Data was analyzed using Epi-info 7.2 statistical software and P value < 0.05 was considered significant. The prevalent major CVD risk factors were dyslipidaemia (30.0% versus 6.0%), hypertension (34.0% versus 10.0%) and diabetes mellitus (10.0% versus 2.0%) among the HIV+ and HIV- participants respectively. The FRS of the HIV+, 3 (IQR 3-28) were statistically significantly higher than that of the HIV- participants, 2 (IQR 1-13); P=0.001. Furthermore, 32% of the HIV+ had moderate-high FRS compared to 2% of HIV- participants. CD4 count ≤ 200 cells/ml, use of anti-retroviral (ART), ART use ≥ 2 years and use of protease inhibitors (PI) emerged as predictors of moderate-high FRS among the HIV+ participants. In conclusion, a high prevalence of CVD risk factors exists among HIV+ population in our local environment. These risk factors can be identified early by baseline/periodic cardiovascular work-up which should include use of CVD risk tools. Early diagnosis and treatment will significantly reduce morbidity and mortality in these patients.
Highlights
IntroductionThe acquired immune deficiency syndrome (AIDS) has been described as a global pandemic by the United nations (UN) and World Health Organization (WHO).[1,2] The burden is disproportionately high in subSaharan Africa where it causes significant morbidity and mortality mostly in the young and productive age groups.[1,2] Over 20 million deaths globally have been attributed to HIV infection, with about 75% of these occurring in sub-SaharanAfrica alone.[1,2] Nigeria has the second largest population of HIV infected persons in the world.[1,2,3] According to the 2018 Nigeria HIV /AIDS Indicator and Impact Survey (NAIIS), the current national prevalence is 3.1%.3With a population of more than 140 million people, this represents over 10% of the global pandemic in terms of absolute numbers .1-3 The introduction of anti-retroviral therapy (ART) in 1996 has led to a gradual decline in morbidity, mortality rate and a change in causes of death in persons living with HIV/AIDS (PLWHA).[4,5] Significant numbers of PLWHA are estimated to be over 50 years of age.[4,5] This has brought to pre-eminence other causes of morbidity and mortality cardiovascular diseases among PLWHA.[1,2,3,4,5] HIV/AIDS is known to have a significant negative impact on the cardiovascular system in protean ways.[6,7,8,9] The possible mechanistic pathways are the direct cardiotoxic effects of the virus, metabolic changes induced by the virus and ART, and certain predisposing lifestyles like smoking, alcohol abuse and drug abuse commoner among PLWHA.[6,7,8,9] In PLWHA, concerns have been expressed about the emergence of a cardiovascular disease epidemic within the AIDS pandemic.[1,2,3,4,5,10] A preponderance of studies report that CVD increasingly account for significant proportion of morbidity and mortality (30% cause of mortality and more than 50% increase in all-cause mortality) among PLWHA.[11,12,13,14,15,16] Others have reported that certain classes of ART i.e. nucleoside reverse transcriptase inhibitors (NRTIs) and protease inhibitors (PIs) are associated with inducing metabolic syndrome which is a cluster of cardiovascular risk factors.[17,18,19,20,21,22,23] some have advocated for HIV infection to be classified as a major CVD risk factor.[10]
This study aims to add to the available evidence in literature on the burden of CVD risk factors and assessment of CVD risk using the Framingham risk score (FRS) in Nigeria where similar studies are very few
This study set out to evaluate the prevalence of specific cardiovascular disease risk factors, assessment of these risks using the Framingham risk score and the predictors of moderate-high Framingham risk scores in persons living with HIV/acquired immune deficiency syndrome (AIDS) seen at the HIV clinic of Jos University Teaching Hospital
Summary
The acquired immune deficiency syndrome (AIDS) has been described as a global pandemic by the United nations (UN) and World Health Organization (WHO).[1,2] The burden is disproportionately high in subSaharan Africa where it causes significant morbidity and mortality mostly in the young and productive age groups.[1,2] Over 20 million deaths globally have been attributed to HIV infection, with about 75% of these occurring in sub-SaharanAfrica alone.[1,2] Nigeria has the second largest population of HIV infected persons in the world.[1,2,3] According to the 2018 Nigeria HIV /AIDS Indicator and Impact Survey (NAIIS), the current national prevalence is 3.1%.3With a population of more than 140 million people, this represents over 10% of the global pandemic in terms of absolute numbers .1-3 The introduction of anti-retroviral therapy (ART) in 1996 has led to a gradual decline in morbidity, mortality rate and a change in causes of death in persons living with HIV/AIDS (PLWHA).[4,5] Significant numbers of PLWHA are estimated to be over 50 years of age.[4,5] This has brought to pre-eminence other causes of morbidity and mortality cardiovascular diseases among PLWHA.[1,2,3,4,5] HIV/AIDS is known to have a significant negative impact on the cardiovascular system in protean ways.[6,7,8,9] The possible mechanistic pathways are the direct cardiotoxic effects of the virus, metabolic changes induced by the virus and ART, and certain predisposing lifestyles like smoking, alcohol abuse and drug abuse commoner among PLWHA.[6,7,8,9] In PLWHA, concerns have been expressed about the emergence of a cardiovascular disease epidemic within the AIDS pandemic.[1,2,3,4,5,10] A preponderance of studies report that CVD increasingly account for significant proportion of morbidity and mortality (30% cause of mortality and more than 50% increase in all-cause mortality) among PLWHA.[11,12,13,14,15,16] Others have reported that certain classes of ART i.e. nucleoside reverse transcriptase inhibitors (NRTIs) and protease inhibitors (PIs) are associated with inducing metabolic syndrome which is a cluster of cardiovascular risk factors.[17,18,19,20,21,22,23] some have advocated for HIV infection to be classified as a major CVD risk factor.[10]. There is a growing call for baseline/periodic assessment of CVD risk factors in PLWHA. The FRS has been found useful in assessing CVD risk in PLHWA and has been validated for use among different races.[24,25,26,27] This study aims to add to the available evidence in literature on the burden of CVD risk factors and assessment of CVD risk using the FRS in Nigeria where similar studies are very few
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