Burden of subclinical carotid atherosclerosis and vascular risk factors among people living with HIV in Ghana

• Published in: Journal of the neurological sciences 2019-02, Vol.397, p.103-111
• Main Authors: Sarfo, Fred Stephen, Nichols, Michelle, Agyei, Benedict, Singh, Arti, Ennin, Eugenia, Nyantakyi, Adu Darko, Asibey, Shadrack Osei, Tagge, Raelle, Gebregziabher, Mulugeta, Jenkins, Carolyn, Ovbiagele, Bruce
• Format: Article
• Language: English
• Subjects: Adult; Anti-Retroviral Agents - therapeutic use; Cardiovascular Diseases - epidemiology; Cardiovascular risk; Carotid Arteries - diagnostic imaging; Carotid Artery Diseases - diagnostic imaging; Carotid Artery Diseases - epidemiology; Carotid atherosclerosis; Carotid Intima-Media Thickness; Comorbidity; Cross-Sectional Studies; Dyslipidemia; Female; Ghana - epidemiology; HIV; HIV Infections - drug therapy; HIV Infections - epidemiology; Humans; Male; Middle Aged; Prevalence; Risk Factors; Severity of Illness Index; Stroke
• ISSN: 0022-510X; 1878-5883
• DOI: 10.1016/j.jns.2018.12.026

The burden of cardiovascular disease (CVD) among people living with HIV (PLWH) in sub-Saharan Africa is projected to rise due to a rapid epidemiological transition and improved treatment of HIV infection on the sub-continent. The Evaluation of Vascular Event Risk while on Long-term Anti-retroviral Suppressive Therapy (EVERLAST) Study sought to assess the extent of subclinical atherosclerosis and characterize the nature of CVD risk factors among HIV patients on Antiretroviral therapy (ART) in Ghana. We conducted a cross-sectional study involving HIV patients on antiretroviral therapy (n = 250) in comparison with HIV positive ART naïve (n = 201), and HIV uninfected controls (n = 250). We assessed prevalence of hypertension, dyslipidemia, diabetes mellitus, central obesity, and carotid atherosclerosis using B-mode carotid Doppler ultrasonography. We assessed factors associated with subclinical atherosclerosis defined by a carotid intimal media thickness (CIMT) cut-off of ≥0.78 mm among PLWH using a logistic regression model. Mean age of PLWH on combination ART (cART) was 45.7 ± 8.6 years, 42.9 ± 8.8 years among PLWH not on cART, and 44.9 ± 9.5 years among HIV negative controls of which 81.2%, 81.6% and 81.1% respectively were females. Prevalence of subclinical atherosclerosis at the common carotid artery in the three groups was 67.6%, 66.7% and 62.4%, p = 0.43. Among PLWH, raised serum total cholesterol (OR 1.16, 95% CI: 1.00–1.35) and triglycerides (OR 1.32, 95% CI: 1.01–1.73) were significantly associated with subclinical atherosclerosis. Prevalence of vascular risk factors among PLWH on cART, PLWH cART naïve, and HIV negative controls respectively were as follows: dyslipidemia- 79.5%, 83.1%, and 73.5%, p = 0.04; hypertension- 40.2%, 23.4%, and 44.9%, p