Abstract
BackgroundThe association between HIV and cardiovascular disease (CVD) has been reported in several studies. However, there is paucity of information on the prevalence of subclinical disease as well as its associated risk factors in sub-Saharan African population. The aim of this study was to determine the prevalence and associated risk factors of peripheral artery disease (PAD) among virologically suppressed HIV-infected participants in Kwara State, Nigeria.MethodsThis study was conducted between July 2018 and December 2018. A total of 150 HIV-infected participants aged between 20 and 55 years and 50 HIV non-infected age-matched controls were randomly recruited in the study. Sociodemographic, anthropometric and clinical data were collected using a well-structured questionnaire. Ankle brachial index (ABI) was measured, PAD was defined as ABI of < 0.9. Cryopreserved serum was used to evaluate lipid profile parameters. Student’s t-test and Chi-square were used to compare continuous and categorical variables. Associations of CVD risk factors and clinical data, and lipid profile with low ABI were assessed using logistic regression analysis.ResultsThe study participants had a mean age of 43.73 ± 8.74, majority were females (72.7%) with a mean duration on ART of 7.73 ± 3.52 years. Hypertension was present in 15.9%, diabetes 4%, family history of CVD 8.6% and metabolic syndrome 17.3% in the study group. The study participants recorded significantly lower mean values for ABI, HDL-C and significantly higher mean values of TG (P < 0.05) compared to the control group. The prevalence of low ABI (14.6%) was higher in the study group compared to the control group (2%). A significantly negative correlation between ABI and duration on ART (r = − 0.163, P = 0.041) and a positive correlation between viral load and TG were observed in the study group. TC (OR 1.784, P = 0.011), LDL-C (OR 1.824, P = 0.010) and CD4 cell count < 200 cells/mm3 (OR 2.635, P = 0.364) were associated with low ABI in the participants.ConclusionViral suppression with combined antiretroviral therapy and long term treatment is associated with dyslipidaemia, with increased risk of PAD. Prevalence of PAD in virologically-suppressed individuals does not differ from the controls in the population studied.
Highlights
The association between Human Immunodeficiency Virus (HIV) and cardiovascular disease (CVD) has been reported in several studies
Participant characteristics Ankle brachial index (ABI), anthropometric measurements, lipid profile parameters and fasting plasma glucose (FPG) were evaluated in a total of 200 participants; 150 virologically suppressed (VL < 1000 copies/ml, WHO standard for Low- and middle-income countries) HIV-infected participants on antiretroviral therapy (ART) and 50 uninfected control group
Comparison of ankle brachial index measurement and cardiovascular risk factors in the study and control group Triglycerides and fasting plasma glucose were significantly higher in the study group compared to the control group while the control group recorded significantly higher high-density lipoproteincholesterol (HDL-C) compared to the study group (P < 0.05)
Summary
The association between HIV and cardiovascular disease (CVD) has been reported in several studies. In the last 20 years, there has been consistent decline in the incidence and mortality of AIDS-defining illnesses linked to severe end-stage immune suppression, whereas the role of non-AIDS comorbidities has risen [3,4,5,6]. These reports have come mainly from high- and middle-income countries [7, 8], with very few reports from low-income countries, sub-Saharan Africa [9, 10]. Greater prevalence and risk of CVD has been reported in long-term–treated patients than age-matched uninfected adults, without sufficient knowledge for the reason [7], and the underlying mechanism causing the high risk of non-AIDS complications is most likely multifactorial and includes comorbid conditions and toxicity from antiretroviral therapy [12, 13]
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