Lipoprotein(a) and High Sensitivity C-Reactive Protein among Patients with HIV in Ghana: The Study on Cardiovascular Risk Profile of HIV-Infected Patients on HAART (SCRIPT).

Lambert Tetteh Appiah,Mark D Huffman,Fred Stephen Sarfo,Matthew J Feinstein,Samuel Blay Nguah,Jonathan K Stiles

doi:10.5334/gh.850

Abstract

Background:Lipoprotein(a) [Lp(a)] and high-sensitivity C-reactive protein (hs-CRP) levels are associated with cardiovascular disease (CVD) in the general population, even after adjusting for conventional CVD risk factors. However, data are limited regarding the distribution of Lp(a) and hs-CRP among patients with HIV in Ghana. We explored levels of Lp(a), hs-CRP and other cardiovascular risk factors among people who were HIV positive (HIV+) on ART (HIV+ART+), HIV+ART–, and HIV–ART– in a Ghanaian population.Methods:We conducted a cross sectional study, recruited individuals who were HIV+ART+ and HIV+ART– from the largest HIV clinic in central Ghana between August 2018 and December 2019. HIV negative controls were recruited from communities and adjoining suburbs of Kumasi. Lipoprotein(a) was measured using Immunoturbidimetric assay and high sensitive-CRP concentrations were determined using particle-enhanced turbidimetric assay. We compared levels of Lp(a), hs-CRP, and conventional CVD risk factors among these groups and used multivariable stepwise logistic regression models to explore associations between them.Results:Among HIV+ART+ (n = 156), HIV+ART– (n = 131), and HIV–ART– (n = 147), mean(SD) ages were 48 (9.1) years, 41 (11.1) years and 45 (11.9) years, p = <0.001, proportion of females were 71.2%, 67.9% and 73.5% respectively. Median(IQR) concentrations of hs-CRP in mg/L were 1.7 (0.8,4.5), 2.03 (0.5,8.58) and 1.0 (0.45,2.74) across respective groups and the proportion of elevated Lp(a) concentrations (Lp[a] > 30mg/dL) were 70%, 48% and 62% among HIV+ART+,HIV+ART– and HIV–ART– participants respectively. Diabetes mellitus, dyslipidemia, waist-to-hip ratio and metabolic syndrome were associated with higher hs-CRP levels. Compared to HIV–ART–, HIV+ patients had higher odds of having hs-CRP > 3mg/L while HIV+ART+ patients had higher odds of elevated Lp(a) than HIV+ART– after multivariable adjustment.Conclusion:PLWHA in Ghana are associated with higher odds of elevated hs-CRP, regardless of ART use. HIV+ART+ is significantly associated with higher odds of elevated Lp(a) levels compared to HIV+ART–; even after multivariable adjustments. Reasons for this and potential clinical implications merit further study.

Highlights

Sub-Saharan Africa (SSA) has seen a dramatic improvement in the life expectancy and quality of life of people living with HIV/AIDS (PLWHA) with the advent, scale-up, and sustained use of effective antiretroviral therapy (ART) since 2004 [1]
Lipoprotein(a) [Lp(a)] and high sensitivity C-reactive protein are of interest given their associations with cardiovascular disease (CVD) risk and their roles in pro-inflammatory atherogenic dyslipidemia and general inflammation, respectively
Elevated lipoprotein(a),though predominantly determined by genetic factors [8], is an established independent atherosclerotic CVD risk factor described in the general population akin to conventional LDL cholesterol(LDL-C)

Summary

Introduction

Sub-Saharan Africa (SSA) has seen a dramatic improvement in the life expectancy and quality of life of people living with HIV/AIDS (PLWHA) with the advent, scale-up, and sustained use of effective antiretroviral therapy (ART) since 2004 [1]. Non-AIDSrelated complications occur approximately 10 years earlier among PLWHA compared to the general population, suggesting an acceleration of the ageing process in the course of the infection [4] This may result from the complex interplay between HIV-related factors, including immune dysregulation and inflammation, and conventional and emerging risk factors for common diseases, including cardiovascular disease (CVD). Conventional CVD risk factors have been studied and found to be prevalent among both HIV infected patients and the general population in Ghana [5,6,7] In this context, lipoprotein(a) [Lp(a)] and high sensitivity C-reactive protein (hs-CRP) are of interest given their associations with CVD risk and their roles in pro-inflammatory atherogenic dyslipidemia and general inflammation, respectively. Reasons for this and potential clinical implications merit further study

Methods

Results

Conclusion