Carotid Intima Media Thickness in Mainly Female HIV-Infected Subjects in Rural South Africa: Association With Cardiovascular but Not HIV-Related Factors

• Published in: Clinical infectious diseases 2015-11, Vol.61 (10), p.1606-1614
• Main Authors: Schoffelen, Annelot F., de Groot, Eric, Tempelman, Hugo A., Visseren, Frank L. J., Hoepelman, Andy I. M., Barth, Roos E.
• Format: Article
• Language: English
• Subjects: Adult; Atherosclerosis - epidemiology; Cardiovascular disease; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - pathology; Carotid Intima-Media Thickness; Cross-Sectional Studies; Demographics; Female; Females; HIV; HIV Infections - complications; HIV/AIDS; Human immunodeficiency virus; Humans; Male; Medical screening; Middle Aged; Risk Assessment; Risk factors; Rural Population; South Africa
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/cid/civ586

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.