Abstract
BackgroundSub-Saharan Africa (SSA) has confronted decades of the HIV epidemic with substantial improvements in access to life-saving antiretroviral therapy (ART). Now, with improved survival, people living with HIV (PLWH) are at increased risk for non-communicable diseases (NCDs), including atherosclerotic cardiovascular disease (CVD). We assessed the existing literature regarding the association of CVD outcomes and HIV in SSA.MethodsWe used the PRISMA guidelines to perform a systematic review of the published literature regarding the association of CVD and HIV in SSA with a focus on CVD surrogate and clinical outcomes in PLWH.ResultsFrom January 2000 until March 2017, 31 articles were published regarding CVD outcomes among PLWH in SSA. Data from surrogate CVD outcomes (n = 13) suggest an increased risk of CVD events among PLWH in SSA. Although acute coronary syndrome is reported infrequently in SSA among PLWH, limited data from five studies suggest extensive thrombus and hypercoagulability as contributing factors. Additional studies suggest an increased risk of stroke among PLWH (n = 13); however, most data are from immunosuppressed ART-naïve PLWH and thus are potentially confounded by the possibility of central nervous system infections.ConclusionsGiven ongoing gaps in our current understanding of CVD and other NCDs in PLWH in SSA, it is imperative to ascertain the burden of CVD outcomes, and to examine strategies for intervention and best practices to enhance the health of this vulnerable population.
Highlights
Sub-Saharan Africa (SSA) has confronted decades of the HIV epidemic with substantial improvements in access to life-saving antiretroviral therapy (ART)
We identified articles published from January 2000 to March 2017 through searches in PubMed that included Medical Subject Headings (MeSH) terms, “Africa” and “HIV,” as well as any of the following terms: “cardiovascular disease,” “cardiometabolic,” “metabolic syndrome,” “myocardial infarction,” “acute coronary syndrome,” “dyslipidemia,” “diabetes,” “dysglycemia,” “hypertension,” “surrogate marker,” “Carotid intima media thickness (cIMT),” “pulse wave velocity,” “aortic augmentation index,” “ankle-brachial index,” “endothelial activation,” “radial tonometry,” “flow-mediated dilation,” or “stroke.” We included additional articles found in review of bibliographies or suggested by co-authors based on their relevance to the selected search terms
Study selection Full-text articles selected for eligibility were further separated into cardiovascular disease (CVD) risk factors (n = 123), biomarkers of immune status and endothelial activation (n = 12), and CVD outcomes (n = 31) (Fig. 2)
Summary
Sub-Saharan Africa (SSA) has confronted decades of the HIV epidemic with substantial improvements in access to life-saving antiretroviral therapy (ART). With improved survival, people living with HIV (PLWH) are at increased risk for non-communicable diseases (NCDs), including atherosclerotic cardiovascular disease (CVD). With more than 26 million people living with human immunodeficiency virus (PLWH) in sub-Saharan Africa (SSA), the daunting immediacy of health needs has necessitated expanding infrastructure to provide care for HIV infection [1]. As the beneficial effects of antiretroviral therapy (ART) are increasingly apparent [2], attention has shifted to expanding this growing healthcare infrastructure to encompass chronic care for noninfectious, highly prevalent co-morbidities [3, 4]. Non-communicable diseases (NCDs), cardiovascular disease (CVD), increasingly affect the general population in SSA [5,6,7]. Interventions in prevention, screening, and treatment have been shown to be effective and cost-effective among the general population [15, 16]
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