Kwame Nkrumah University of Science & Technology, Kumasi, Ghana; Komfo Anokye Teaching Hospital, Kumasi, Ghana.
Medical University of South Carolina, Charleston, USA.
J Neurol Sci. 2019 Feb 15;397:103-111. doi: 10.1016/j.jns.2018.12.026. Epub 2018 Dec 19.
The burden of cardiovascular disease (CVD) among people living with HIV (PLWH) in sub-Saharan Africa is projected to rise due to a rapid epidemiological transition and improved treatment of HIV infection on the sub-continent.
The Evaluation of Vascular Event Risk while on Long-term Anti-retroviral Suppressive Therapy (EVERLAST) Study sought to assess the extent of subclinical atherosclerosis and characterize the nature of CVD risk factors among HIV patients on Antiretroviral therapy (ART) in Ghana.
We conducted a cross-sectional study involving HIV patients on antiretroviral therapy (n = 250) in comparison with HIV positive ART naïve (n = 201), and HIV uninfected controls (n = 250). We assessed prevalence of hypertension, dyslipidemia, diabetes mellitus, central obesity, and carotid atherosclerosis using B-mode carotid Doppler ultrasonography. We assessed factors associated with subclinical atherosclerosis defined by a carotid intimal media thickness (CIMT) cut-off of ≥0.78 mm among PLWH using a logistic regression model.
Mean age of PLWH on combination ART (cART) was 45.7 ± 8.6 years, 42.9 ± 8.8 years among PLWH not on cART, and 44.9 ± 9.5 years among HIV negative controls of which 81.2%, 81.6% and 81.1% respectively were females. Prevalence of subclinical atherosclerosis at the common carotid artery in the three groups was 67.6%, 66.7% and 62.4%, p = 0.43. Among PLWH, raised serum total cholesterol (OR 1.16, 95% CI: 1.00-1.35) and triglycerides (OR 1.32, 95% CI: 1.01-1.73) were significantly associated with subclinical atherosclerosis. Prevalence of vascular risk factors among PLWH on cART, PLWH cART naïve, and HIV negative controls respectively were as follows: dyslipidemia- 79.5%, 83.1%, and 73.5%, p = 0.04; hypertension- 40.2%, 23.4%, and 44.9%, p < 0.0001; central obesity-61.8%, 66.7%, and 78.2%, p < 0.0001; diabetes mellitus-6.8%, 5.5% and 4.9%, p = 0.53.
Overall while there is a high baseline prevalence of CVD risk factors in the Ghanaian population, serum lipid derangements appear to be more prevalent among HIV infected patients, and are linked to sub-clinical atherosclerosis. Future studies need to confirm these findings, explore the underlying pathophysiology, and optimize treatment strategies to avert untoward CVD outcomes.
在撒哈拉以南非洲地区，心血管疾病（CVD）在艾滋病毒感染者（PLWH）中的负担预计会增加，这是由于该地区艾滋病毒感染的快速流行病学转变和治疗的改善。
评估长期抗逆转录病毒抑制治疗期间的血管事件风险（EVERLAST）研究旨在评估撒哈拉以南非洲地区接受抗逆转录病毒治疗（ART）的 HIV 患者亚临床动脉粥样硬化的程度，并描述 CVD 危险因素的性质。
我们进行了一项横断面研究，纳入了 250 名接受抗逆转录病毒治疗（ART）的 HIV 患者（n=250），并与 HIV 阳性未接受 ART 治疗（n=201）和 HIV 阴性对照组（n=250）进行了比较。我们使用 B 型颈动脉多普勒超声评估了高血压、血脂异常、糖尿病、中心性肥胖和颈动脉粥样硬化的患病率。我们使用逻辑回归模型评估了与 PLWH 亚临床动脉粥样硬化（定义为颈动脉内膜中层厚度（CIMT）≥0.78mm）相关的因素。
接受联合抗逆转录病毒治疗（cART）的 PLWH 的平均年龄为 45.7±8.6 岁，未接受 cART 的 PLWH 的平均年龄为 42.9±8.8 岁，HIV 阴性对照组的平均年龄为 44.9±9.5 岁，其中分别有 81.2%、81.6%和 81.1%为女性。三组患者的颈总动脉亚临床动脉粥样硬化患病率分别为 67.6%、66.7%和 62.4%，p=0.43。在 PLWH 中，血清总胆固醇（OR 1.16，95%CI：1.00-1.35）和甘油三酯（OR 1.32，95%CI：1.01-1.73）升高与亚临床动脉粥样硬化显著相关。接受 cART 的 PLWH、未接受 cART 的 PLWH 和 HIV 阴性对照组的血管危险因素患病率分别为：血脂异常-79.5%、83.1%和 73.5%，p=0.04；高血压-40.2%、23.4%和 44.9%，p<0.0001；中心性肥胖-61.8%、66.7%和 78.2%，p<0.0001；糖尿病-6.8%、5.5%和 4.9%，p=0.53。
尽管加纳人群中 CVD 危险因素的基线患病率较高，但血清脂质异常似乎在 HIV 感染者中更为普遍，并且与亚临床动脉粥样硬化有关。未来的研究需要证实这些发现，探讨潜在的病理生理学，并优化治疗策略，以避免不良的 CVD 结局。
