Carotid Intima Media Thickness in Mainly Female HIV-Infected Subjects in Rural South Africa: Association With Cardiovascular but Not HIV-Related Factors. (27th July 2015)

• Record Type: Journal Article
• Authors: Schoffelen, Annelot F.; de Groot, Eric; Tempelman, Hugo A.; Visseren, Frank L. J.; Hoepelman, Andy I. M.; Barth, Roos E.
• Is Part Of: Clinical infectious diseases. Volume 61:Number 10(2015:Nov 15)
• Page Start: 1606
• Page End: 1614
• Publication Date: 2015-07-27
• Subjects: HIV -- sub-Saharan Africa -- carotid intima media thickness -- atherosclerosis -- cardiovascular risk factors; Communicable diseases -- Periodicals; 616.905
• DOI: 10.1093/cid/civ586
• Languages: English
• ISSNs: 1058-4838

Abstract

Abstract : In a study group of >900 human immunodeficiency virus (HIV)–infected, mainly female individuals in rural South Africa, carotid intima media thickness values are relatively high and subclinical atherosclerosis is associated with traditional cardiovascular risk factors rather than HIV-related factors. Abstract: Background. In sub-Saharan Africa, the number of persons living with human immunodeficiency virus (HIV) has increased immensely. In parallel, rates of noncommunicable diseases, especially cardiovascular disease, are rising rapidly in resource-limited settings. This study aims to evaluate the relation between subclinical atherosclerosis and HIV-related and traditional cardiovascular risk factors in HIV-infected patients in rural South Africa. Methods. A cross-sectional study was performed among HIV-infected patients visiting a health center in Limpopo, South Africa. Demographic and HIV-related information was collected, and cardiovascular risk was assessed. Carotid intima media thickness (CIMT) was measured and the prevalence of subclinical atherosclerosis (CIMT >0.78 mm) was calculated. The association between cardiovascular or HIV-related determinants with CIMT was analyzed using linear and logistic regression models adjusted for age and sex. Results. The median CIMT in 866 subjects (median age [interquartile range], 41 [35–48] years; 69% female) was 0.589 mm (interquartile range, 0.524–0.678 mm), and values seemed higher than in healthy Western reference populations. In fact 12% of subjects (106 of 866) had subclinical atherosclerosis. Hypertension, high body mass index, previous cardiovascular event, diabetes mellitus, total and low-density lipoprotein cholesterol, estimated glomerular filtration rate, metabolic syndrome, and the Framingham Heart Risk score were independently associated with CIMT. No HIV-related determinants were associated with CIMT. Conclusions. In a predominantly female HIV-infected population in South Africa, CIMT values are considerably high and associated with cardiovascular risk factors, rather than HIV-related factors. This finding emphasizes the need to screen for cardiovascular disease among persons with HIV infection in resource-limited settings. Ideally, this screening would be integrated into care for chronic HIV infection, posing a major challenge for the future.