Department of Medicine, Division of Cardiology.
Department of Global Health, University of Washington, Seattle, WA.
Medicine (Baltimore). 2021 Mar 12;100(10):e24800. doi: 10.1097/MD.0000000000024800.
There is increasing morbidity and mortality from cardiovascular diseases (CVD) in sub-Saharan Africa (SSA). Dyslipidemia is a well-known CVD risk factor which has been associated with human immunodeficiency virus (HIV) infection and its treatment in high-income countries. Studies in SSA that have examined the relationship between HIV and dyslipidemia have reported mixed results. In this study, we sought to determine the prevalence of dyslipidemia in HIV positive and negative adults (>=30 years old) and evaluate for association in Western Kenya with a higher prevalence expected among HIV positive individuals.HIV positive adults receiving antiretroviral therapy (ART) and HIV negative individuals seeking HIV testing and counseling services were recruited into a cross-sectional study. Demographic and behavioral data and fasting blood samples were collected. Dyslipidemia was defined according to the National Cholesterol Education Program Adult Treatment Panel III. Associations between baseline demographic and clinical variables and dyslipidemia were analyzed using logistic regression.A total of 598 participants, 300 HIV positive and 298 HIV negative adults were enrolled. Dyslipidemia data was available for 564 (94%) participants. In total, 267 (47%) had dyslipidemia. This was not significantly different between HIV positive and HIV negative individuals (46% vs 49%, P = .4). In a multivariate analysis including both HIV positive and negative individuals, adults 50 to 59 years of age had a 2-fold increased risk of dyslipidemia (Odds ratio [OR] 2.1, 95% confidence interval (1.2-3.5) when compared to 30 to 39-years-old participants. Abdominal obesity (OR 2.5), being overweight (OR 1.9), and low fruit and vegetable intake (OR 2.2) were significantly associated with dyslipidemia. Among HIV positive participants, time since HIV diagnosis, ART duration, use of (PI) protease inhibitor-based ART, viral load suppression, current cluster of differentiation (CD4) count and nadir CD4 did not have significant associations with dyslipidemia.The prevalence of dyslipidemia is high in Western Kenya, with nearly half of all participants with lipid abnormalities. Dyslipidemia was not significantly associated with HIV status, or with HIV-specific factors. Older age, being overweight, abdominal obesity, and low fruit and vegetable intake were associated with dyslipidemia and may be targets for public health interventions to lower the prevalence of dyslipidemia and CVD risk in sub-Saharan Africa.
在撒哈拉以南非洲（SSA），心血管疾病（CVD）的发病率和死亡率正在上升。血脂异常是一种众所周知的 CVD 风险因素，与高收入国家的人类免疫缺陷病毒（HIV）感染及其治疗有关。在 SSA 进行的研究表明，HIV 与血脂异常之间存在关联，但结果不一。在这项研究中，我们旨在确定 HIV 阳性和阴性成年人（>=30 岁）中血脂异常的患病率，并评估在肯尼亚西部的关联，因为 HIV 阳性个体中的患病率预计更高。
我们招募了接受抗逆转录病毒治疗（ART）的 HIV 阳性成年人和寻求 HIV 检测和咨询服务的 HIV 阴性个体，进行了一项横断面研究。收集了人口统计学和行为数据以及空腹血样。根据国家胆固醇教育计划成人治疗小组 III 血脂异常的定义。使用逻辑回归分析了基线人口统计学和临床变量与血脂异常之间的关联。
共有 598 名参与者，其中 300 名 HIV 阳性，298 名 HIV 阴性成年人参加了研究。可获得 564 名（94%）参与者的血脂异常数据。共有 267 名（47%）有血脂异常。HIV 阳性和 HIV 阴性个体之间无显著差异（46%与 49%，P=0.4）。在包括 HIV 阳性和阴性个体的多变量分析中，50 至 59 岁的成年人血脂异常的风险增加了 2 倍（与 30 至 39 岁参与者相比，比值比 [OR] 2.1，95%置信区间 [1.2-3.5）。腹部肥胖（OR 2.5）、超重（OR 1.9）和低水果和蔬菜摄入量（OR 2.2）与血脂异常显著相关。在 HIV 阳性参与者中，HIV 诊断时间、ART 持续时间、使用（PI）蛋白酶抑制剂为基础的 ART、病毒载量抑制、当前 CD4 计数和最低 CD4 计数与血脂异常无显著关联。
在肯尼亚西部，血脂异常的患病率很高，近一半的参与者存在脂质异常。血脂异常与 HIV 状态或 HIV 特异性因素无显著关联。年龄较大、超重、腹部肥胖和低水果和蔬菜摄入量与血脂异常相关，可能是降低撒哈拉以南非洲血脂异常和 CVD 风险的公共卫生干预措施的目标。
