Komfo Anokye Teaching Hospital, Kumasi, GH.
Kwame Nkrumah University of Science andTechnology, School of Medicine and Dentistry, Kumasi, GH.
Glob Heart. 2020 Nov 3;15(1):74. doi: 10.5334/gh.850.
Lipoprotein(a) [Lp(a)] and high-sensitivity C-reactive protein (hs-CRP) levels are associated with cardiovascular disease (CVD) in the general population, even after adjusting for conventional CVD risk factors. However, data are limited regarding the distribution of Lp(a) and hs-CRP among patients with HIV in Ghana. We explored levels of Lp(a), hs-CRP and other cardiovascular risk factors among people who were HIV positive (HIV+) on ART (HIV+ART+), HIV+ART-, and HIV-ART- in a Ghanaian population.
We conducted a cross sectional study, recruited individuals who were HIV+ART+ and HIV+ART- from the largest HIV clinic in central Ghana between August 2018 and December 2019. HIV negative controls were recruited from communities and adjoining suburbs of Kumasi. Lipoprotein(a) was measured using Immunoturbidimetric assay and high sensitive-CRP concentrations were determined using particle-enhanced turbidimetric assay. We compared levels of Lp(a), hs-CRP, and conventional CVD risk factors among these groups and used multivariable stepwise logistic regression models to explore associations between them.
Among HIV+ART+ (n = 156), HIV+ART- (n = 131), and HIV-ART- (n = 147), mean(SD) ages were 48 (9.1) years, 41 (11.1) years and 45 (11.9) years, p = <0.001, proportion of females were 71.2%, 67.9% and 73.5% respectively. Median(IQR) concentrations of hs-CRP in mg/L were 1.7 (0.8,4.5), 2.03 (0.5,8.58) and 1.0 (0.45,2.74) across respective groups and the proportion of elevated Lp(a) concentrations (Lp[a] > 30mg/dL) were 70%, 48% and 62% among HIV+ART+,HIV+ART- and HIV-ART- participants respectively. Diabetes mellitus, dyslipidemia, waist-to-hip ratio and metabolic syndrome were associated with higher hs-CRP levels. Compared to HIV-ART-, HIV+ patients had higher odds of having hs-CRP > 3mg/L while HIV+ART+ patients had higher odds of elevated Lp(a) than HIV+ART- after multivariable adjustment.
PLWHA in Ghana are associated with higher odds of elevated hs-CRP, regardless of ART use. HIV+ART+ is significantly associated with higher odds of elevated Lp(a) levels compared to HIV+ART-; even after multivariable adjustments. Reasons for this and potential clinical implications merit further study.
脂蛋白(a)[Lp(a)]和高敏 C 反应蛋白（hs-CRP）水平与普通人群中的心血管疾病（CVD）相关，即使在调整了传统 CVD 风险因素后也是如此。然而，关于加纳 HIV 患者中 Lp(a)和 hs-CRP 的分布数据有限。我们在加纳人群中研究了接受抗逆转录病毒治疗（ART）的 HIV 阳性（HIV+ART+）、未接受 ART 的 HIV 阳性（HIV+ART-）和 HIV 阴性（HIV-ART-）患者的 Lp(a)、hs-CRP 和其他心血管风险因素的水平。
我们进行了一项横断面研究，从 2018 年 8 月至 2019 年 12 月期间，从加纳最大的 HIV 诊所招募了 HIV+ART+和 HIV+ART-的患者。HIV 阴性对照来自库马西的社区和邻近郊区。使用免疫比浊法测量脂蛋白(a)，使用粒子增强比浊法测定高敏-CRP 浓度。我们比较了这些组之间的 Lp(a)、hs-CRP 和传统 CVD 风险因素的水平，并使用多变量逐步逻辑回归模型来探讨它们之间的关联。
在 HIV+ART+（n=156）、HIV+ART-（n=131）和 HIV-ART-（n=147）中，平均（SD）年龄分别为 48（9.1）岁、41（11.1）岁和 45（11.9）岁，p<0.001，女性比例分别为 71.2%、67.9%和 73.5%。hs-CRP 的中位数（IQR）浓度（mg/L）分别为 1.7（0.8，4.5）、2.03（0.5，8.58）和 1.0（0.45，2.74），在各自的组中，Lp(a)浓度升高（Lp[a]>30mg/dL）的比例分别为 70%、48%和 62%。糖尿病、血脂异常、腰臀比和代谢综合征与 hs-CRP 水平升高相关。与 HIV-ART-相比，HIV+患者的 hs-CRP>3mg/L 的可能性更高，而 HIV+ART+患者的 Lp(a)水平升高的可能性高于 HIV+ART-，即使在多变量调整后也是如此。
加纳的 PLWHA 与 hs-CRP 升高的可能性更高相关，无论是否使用 ART。与 HIV+ART-相比，HIV+ART+与 hs-CRP 升高的可能性更高显著相关；即使在多变量调整后也是如此。这种情况的原因和潜在的临床意义值得进一步研究。
