Abstract
BackgroundThe extent to which the risk of atherosclerotic cardiovascular disease (ACVD) is increased among people living with HIV (PLWH) in sub-Saharan Africa remains unknown.SettingCross-sectional analysis nested within the Ugandan Noncommunicable Diseases and Aging Cohort, including PLWH in rural Uganda > 40 years taking antiretroviral therapy (ART) for at least 3 years, and a population-based control group of HIV-uninfected age- and sex-matched persons.MethodsWe conducted carotid ultrasonography and collected ACVD risk factor data. Our outcome of interest was carotid plaque, defined as > 1.5 mm thickness from the intima-lumen interface to the media-adventitia interface. We fit multivariable logistic regression models to estimate correlates of carotid plaque including HIV-specific and traditional cardiovascular risk factors.ResultsWe enrolled 155 (50.2%) PLWH and 154 (49.8%) HIV-uninfected comparators, with a mean age of 51.4 years. Among PLWH, the median CD4 count was 433 cells/mm3 and 97.4% were virologically suppressed. Carotid plaque prevalence was higher among PLWH (8.4% vs 3.3%). HIV infection (aOR 3.90; 95% CI 1.12–13.60) and current smokers (aOR 6.60; 95% CI 1.22–35.80) had higher odds of carotid plaque, whereas moderate (aOR 0.13, 95% CI 0.01–1.55) and vigorous intensity of physical activity (aOR 0.34, 95% CI 0.07–1.52) were associated with decreased odds of carotid plaque.ConclusionIn rural Uganda, PLWH have higher prevalence of carotid plaque compared to age- and sex-matched HIV-uninfected comparators. Future work should explore how biomedical and lifestyle modifications might reduce atherosclerotic burden among PLWH in the region.
Highlights
The extent to which the risk of atherosclerotic cardiovascular disease (ACVD) is increased among peo‐ ple living with HIV (PLWH) in sub-Saharan Africa remains unknown.Setting: Cross-sectional analysis nested within the Ugandan Noncommunicable Diseases and Aging Cohort, includ‐ ing PLWH in rural Uganda > 40 years taking antiretroviral therapy (ART) for at least 3 years, and a population-based control group of HIV-uninfected age- and sex-matched persons
In rural Uganda, PLWH have higher prevalence of carotid plaque compared to age- and sex-matched HIV-uninfected comparators
Like the MultiCenter AIDS Cohort Stuudy (MACS) in the US have shown that while there was no difference in carotid intima media thickness (cIMT), there was a difference in carotid plaque [13] and this remains unstudied in Uganda
Summary
The extent to which the risk of atherosclerotic cardiovascular disease (ACVD) is increased among peo‐ ple living with HIV (PLWH) in sub-Saharan Africa remains unknown.Setting: Cross-sectional analysis nested within the Ugandan Noncommunicable Diseases and Aging Cohort, includ‐ ing PLWH in rural Uganda > 40 years taking antiretroviral therapy (ART) for at least 3 years, and a population-based control group of HIV-uninfected age- and sex-matched persons. The extent to which the risk of atherosclerotic cardiovascular disease (ACVD) is increased among peo‐ ple living with HIV (PLWH) in sub-Saharan Africa remains unknown. There are few data on the epidemiology of atherosclerosis among PLWH in sub-Saharan Africa, which is home to at least 70% of the global burden of HIV [1]. We sought to respond to this gap by estimating the prevalence of carotid plaque in a Ugandan cohort of PLWH and age- and sex-matched HIV-uninfected comparators. Previous studies have shown that there was no difference in carotid intima media thickness (cIMT), another predictor of atherosclerotic CVD risk, between PLWH and uninfected comparators [11, 12]. We hypothesized that the prevalence of carotid plaque would be higher among the PLWH compared with their HIV-uninfected comparators
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