Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda; Lown Scholars Program, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Medicine, University of Virginia Health Systems, Charlottesville, VA, USA.
Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda; Department of Neurology, Mayo Clinic, Phoenix/Scottsdale, AZ, USA.
Prog Cardiovasc Dis. 2020 Mar-Apr;63(2):149-159. doi: 10.1016/j.pcad.2020.02.004. Epub 2020 Feb 5.
As longevity has increased for people living with HIV (PLWH) in the United States and Europe, there has been a concomitant increase in the prevalence of cardiovascular disease (CVD) risk factors and morbidity in this population. Whereas the availability of HIV antiretroviral therapy has resulted in dramatic increases in life expectancy in sub-Saharan Africa (SSA), where over two thirds of PLWH reside, if and how these trends impact the epidemiology of CVD is less clear. In this review, we describe the current state of the science on how both HIV and its treatment impact CVD risk factors and outcomes among PLWH in sub-Saharan Africa, including regional factors (unique to SSA) likely to differentiate these relationships from the global North. We then outline how current regional guidelines address CVD prevention among PLWH and which clinical and structural interventions are best poised to confront the co-epidemics of HIV and CVD in the region. We conclude with a discussion of key research gaps that need to be addressed to optimally develop an actionable public health response.
随着美国和欧洲艾滋病毒感染者（PLWH）的寿命延长，该人群心血管疾病（CVD）风险因素和发病率也相应增加。虽然抗逆转录病毒疗法的出现使撒哈拉以南非洲（SSA）的预期寿命大幅延长，而超过三分之二的 PLWH 居住在那里，但这些趋势是否以及如何影响 CVD 的流行病学尚不清楚。在这篇综述中，我们描述了目前关于 HIV 及其治疗如何影响撒哈拉以南非洲 PLWH 的 CVD 风险因素和结果的科学现状，包括可能使这些关系与全球北方有所不同的区域因素（SSA 特有）。然后，我们概述了当前的区域指南如何解决 PLWH 的 CVD 预防问题，以及哪些临床和结构干预措施最适合应对该地区 HIV 和 CVD 的共同流行。最后，我们讨论了需要解决的关键研究空白，以优化制定可行的公共卫生应对措施。
