Effect of cardio-metabolic risk factors on all-cause mortality among HIV patients on antiretroviral therapy in Malawi: A prospective cohort study

• Published in: PloS one 2019-01, Vol.14 (1), p.e0210629-e0210629
• Main Authors: Amberbir, Alemayehu, Banda, Victor, Singano, Victor, Matengeni, Alfred, Pfaff, Colin, Ismail, Zahra, Allain, Theresa J, Chan, Adrienne K, Sodhi, Sumeet K, van Oosterhout, Joep J
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adult; Adults; AIDS; Anti-Retroviral Agents - therapeutic use; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; Biology and Life Sciences; Blood pressure; Body mass; Body mass index; Body size; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - epidemiology; Cause of Death; Cholesterol; Cohort analysis; Comorbidity; Diabetes; Diabetes mellitus; Drug therapy; Dyslipidemia; Female; Health risk assessment; Health risks; High density lipoprotein; HIV; HIV Infections - drug therapy; HIV Infections - epidemiology; HIV Infections - mortality; HIV patients; Human immunodeficiency virus; Humans; Hypertension; Malawi - epidemiology; Male; Medical diagnosis; Medicine; Medicine and Health Sciences; Metabolic Diseases - epidemiology; Metabolism; Middle Aged; Morbidity; Mortality; Patient outcomes; Patients; Prospective Studies; Regression analysis; Risk analysis; Risk Factors; Rural Population - statistics & numerical data; Smoking; Survival analysis; Systematic review; Therapy; Urban Population - statistics & numerical data
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0210629

Cardiovascular disease (CVD) risk among people living with HIV is elevated due to persistent inflammation, hypertension and diabetes comorbidity, lifestyle factors and exposure to antiretroviral therapy (ART). Data from Africa on how CVD risk affects morbidity and mortality among ART patients are lacking. We explored the effect of CVD risk factors and the Framingham Risk Score (FRS) on medium-term ART outcomes. A prospective cohort study of standardized ART outcomes (Dead, Alive on ART, stopped ART, Defaulted and Transferred out) was conducted from July 2014-December 2016 among patients on ART at a rural and an urban HIV clinic in Zomba district, Malawi. The primary outcome was Dead. Active defaulter tracing was not done and patients who transferred out and defaulted were excluded from the analysis. At enrolment, hypertension, diabetes and dyslipidemia were diagnosed, lifestyle data collected and the FRS was determined. Cox-regression analysis was used to determine independent risk factors for the outcome Dead. Of 933 patients enrolled, median age was 42 years (IQR: 35-50), 72% were female, 24% had hypertension, 4% had diabetes and 15.8% had elevated total cholesterol. The median follow up time was 2.4 years. Twenty (2.1%) patients died, 50 (5.4%) defaulted, 63 (6.8%) transferred out and 800 (85.7%) were alive on ART care (81.7% urban vs. 89.9% rural). In multivariable survival analysis, male gender (aHR = 3.28; 95%CI: 1.33-8.07, p = 0.01) and total/HDL cholesterol ratio (aHR = 5.77, 95%CI: 1.21-27.32; p = 0.03) were significantly associated with mortality. There was no significant association between mortality and hypertension, body mass index, central obesity, diabetes, FRS, physical inactivity, smoking at enrolment, ART regimen and WHO disease stage. Medium-term all-cause mortality among ART patients was associated with male gender and elevated total/HDL cholesterol ratio.