Department of Internal Medicine and Infectious Diseases.
Department of ImageLabonline & Cardiovascular, Erichem, The Netherlands.
Clin Infect Dis. 2015 Nov 15;61(10):1606-14. doi: 10.1093/cid/civ586. Epub 2015 Jul 27.
In sub-Saharan Africa, the number of persons living with human immunodeficiency virus (HIV) has increased immensely. In parallel, rates of noncommunicable diseases, especially cardiovascular disease, are rising rapidly in resource-limited settings. This study aims to evaluate the relation between subclinical atherosclerosis and HIV-related and traditional cardiovascular risk factors in HIV-infected patients in rural South Africa.
A cross-sectional study was performed among HIV-infected patients visiting a health center in Limpopo, South Africa. Demographic and HIV-related information was collected, and cardiovascular risk was assessed. Carotid intima media thickness (CIMT) was measured and the prevalence of subclinical atherosclerosis (CIMT >0.78 mm) was calculated. The association between cardiovascular or HIV-related determinants with CIMT was analyzed using linear and logistic regression models adjusted for age and sex.
The median CIMT in 866 subjects (median age [interquartile range], 41 [35-48] years; 69% female) was 0.589 mm (interquartile range, 0.524-0.678 mm), and values seemed higher than in healthy Western reference populations. In fact 12% of subjects (106 of 866) had subclinical atherosclerosis. Hypertension, high body mass index, previous cardiovascular event, diabetes mellitus, total and low-density lipoprotein cholesterol, estimated glomerular filtration rate, metabolic syndrome, and the Framingham Heart Risk score were independently associated with CIMT. No HIV-related determinants were associated with CIMT.
In a predominantly female HIV-infected population in South Africa, CIMT values are considerably high and associated with cardiovascular risk factors, rather than HIV-related factors. This finding emphasizes the need to screen for cardiovascular disease among persons with HIV infection in resource-limited settings. Ideally, this screening would be integrated into care for chronic HIV infection, posing a major challenge for the future.
在撒哈拉以南非洲，感染人类免疫缺陷病毒 (HIV) 的人数大幅增加。与此同时，资源有限的环境中非传染性疾病（尤其是心血管疾病）的发病率也迅速上升。本研究旨在评估南非农村地区 HIV 感染者亚临床动脉粥样硬化与 HIV 相关和传统心血管危险因素之间的关系。
在南非林波波省的一个卫生中心进行了一项 HIV 感染者的横断面研究。收集了人口统计学和 HIV 相关信息，并评估了心血管风险。测量了颈动脉内膜中层厚度 (CIMT)，并计算了亚临床动脉粥样硬化的患病率（CIMT >0.78 毫米）。使用线性和逻辑回归模型分析了心血管或 HIV 相关因素与 CIMT 之间的关联，调整了年龄和性别。
866 名受试者的 CIMT 中位数（中位数 [四分位数范围]，41 [35-48] 岁；69%为女性）为 0.589 毫米（四分位数范围，0.524-0.678 毫米），数值似乎高于健康的西方参考人群。实际上，12%的受试者（866 名中有 106 名）患有亚临床动脉粥样硬化。高血压、高体重指数、既往心血管事件、糖尿病、总胆固醇和低密度脂蛋白胆固醇、估计肾小球滤过率、代谢综合征和弗雷明汉心脏风险评分与 CIMT 独立相关。没有 HIV 相关因素与 CIMT 相关。
在南非一个以女性为主的 HIV 感染者人群中，CIMT 值相当高，与心血管危险因素相关，而与 HIV 相关因素无关。这一发现强调了在资源有限的环境中需要对 HIV 感染者进行心血管疾病筛查。理想情况下，这种筛查应纳入慢性 HIV 感染的护理，这对未来构成了重大挑战。
