乌干达艾滋病毒感染者中冠状动脉粥样硬化的流行病学：一项横断面研究。
Epidemiology of Coronary Atherosclerosis Among People Living With HIV in Uganda : A Cross-Sectional Study.
作者信息
Siedner Mark J, Ghoshhajra Brian, Erem Geoffrey, Nassanga Rita, Randhawa Mangun, Ochieng Andrew, Acan Moses, Lu Michael T, Thondapu Vikas, Takigami Angelo, Reynolds Zahra, Atwiine Flavia, Tindimwebwa Edna, Gilbert Rebecca F, Passell Eliza, Sagar Shruti, Tong Yao, Ntusi Ntobeko A B, Tsai Alexander C, Bibangambah Prossy, Gaziano Thomas, Hoeppner Susanne S, Longenecker Christopher T, Okello Samson, Asiimwe Stephen
机构信息
Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Mbarara University of Science and Technology, Mbarara, Uganda; Africa Health Research Institute, KwaZulu-Natal, South Africa; and University of KwaZulu-Natal, Durban, South Africa (M.J.S.).
Massachusetts General Hospital, Boston; and Harvard Medical School, Boston, Massachusetts (B.G., M.T.L., S.S.H.).
出版信息
Ann Intern Med. 2025 Apr;178(4):468-478. doi: 10.7326/ANNALS-24-02233. Epub 2025 Mar 12.
BACKGROUND
Data on the prevalence of coronary atherosclerotic disease (CAD) in the African region among people with and without HIV are lacking.
OBJECTIVE
To estimate the prevalence of CAD in Uganda and determine whether well-controlled HIV infection is associated with increased presence or severity of CAD.
DESIGN
Cross-sectional study.
SETTING
Southwestern Uganda.
PARTICIPANTS
Ambulatory people living with HIV (PWH), aged older than 40 years, taking antiretroviral therapy for 3 or more years, and population-based, age- and sex-similar people without HIV (PWoH).
MEASUREMENTS
Participants had cardiovascular (CV) disease (CVD) risk profiling and computed tomography scanning for detection of CAD, defined as the presence of calcified or noncalcified plaque.
RESULTS
Of 630 screened, 586 (93%) met criteria and had evaluable images. Of these, 287 (49.0%) were PWH and nearly all (272 of 287 [95%]) were virologically suppressed. Mean age (57.9 vs. 57.4 years), proportion female (49%), and median CVD risk score (4.1 vs. 3.4) did not differ by HIV serostatus. The prevalence of CAD was low overall (45 of 586 [7.7%]) and among both PWH (26 of 287 [9.1%]) and PWoH (19 of 299 [6.4%]; absolute prevalence difference, 2.7% [95% CI, -1.6% to 7.0%]). Results were similar after adjustment for CVD risk factors.
LIMITATIONS
Our findings may not generalize to symptomatic populations or those with greater predicted CVD risk. The study was not powered to detect small differences in CAD prevalence between HIV subgroups. Both PWH and PWoH had similar CV risk factor profiles, but residual confounding between HIV and CAD cannot be excluded.
CONCLUSION
The prevalence of CAD in Uganda was low compared with population-based cohorts from the Global North with similar CVD risk profiles and was similar between HIV serostatus subgroups. Our results suggest that CAD may not be a major cause of morbidity in Uganda.
PRIMARY FUNDING SOURCE
National Institutes of Health.
背景
非洲地区有和没有艾滋病毒的人群中冠状动脉粥样硬化性疾病（CAD）患病率的数据尚缺。
目的
评估乌干达CAD的患病率，并确定HIV感染得到良好控制是否与CAD发生率增加或病情严重程度增加有关。
设计
横断面研究。
地点
乌干达西南部。
参与者
年龄超过40岁、接受抗逆转录病毒治疗3年或更长时间的门诊艾滋病毒感染者（PWH），以及基于人群的、年龄和性别匹配的无艾滋病毒者（PWoH）。
测量
参与者进行心血管（CV）疾病（CVD）风险评估和计算机断层扫描以检测CAD，CAD定义为存在钙化或非钙化斑块。
结果
在630名筛查者中，586名（93%）符合标准并具有可评估图像。其中，287名（49.0%）为PWH，几乎所有（287名中的272名[95%]）病毒学得到抑制。平均年龄（57.9岁对57.4岁）、女性比例（49%）和CVD风险评分中位数（4.1对3.4）在HIV血清学状态之间无差异。CAD总体患病率较低（586名中的45名[7.7%]），在PWH（287名中的26名[9.1%]）和PWoH（299名中的19名[6.4%]；绝对患病率差异为2.7%[95%CI，-1.6%至7.0%]）中均较低。在调整CVD危险因素后结果相似。
局限性
我们的研究结果可能不适用于有症状人群或预测CVD风险较高的人群。该研究没有足够的能力检测HIV亚组之间CAD患病率的微小差异。PWH和PWoH的CV危险因素概况相似，但不能排除HIV与CAD之间的残余混杂因素。
结论
与全球北部具有相似CVD风险概况的基于人群的队列相比，乌干达CAD的患病率较低，且在HIV血清学状态亚组之间相似。我们的结果表明，CAD可能不是乌干达发病的主要原因。
主要资金来源
美国国立卫生研究院。
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