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Cardiovascular risk factors among ART-experienced people with HIV in South Africa
Emily P Hyle1,2,3,4, Linda-Gail Bekker5, Emily B Martey1
1Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA.
Insights
Hypertension and diabetes are common in people with HIV (PWH) on antiretroviral treatment (ART) in South Africa. Many remain undiagnosed or undertreated, highlighting the need for better cardiovascular disease risk management in this population.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- People with HIV (PWH) have an elevated risk of atherosclerotic cardiovascular disease (CVD).
- Routine screening for CVD risk factors is not standard practice in South African HIV clinics.
- Understanding the prevalence of CVD risk factors in this population is crucial for targeted interventions.
Purpose of the Study:
- To determine the prevalence of cardiovascular disease (CVD) risk factors among patients with HIV receiving antiretroviral treatment (ART) in South Africa.
- To describe the diagnostic and treatment status of hypertension and diabetes in this cohort.
- To identify predictors of hypertension in ART-experienced PWH.
Main Methods:
- A prospective, observational, cross-sectional study was conducted with 458 ART-experienced PWH (aged >21 years) in South Africa.
- Data collection included patient interviews, blood pressure measurements, glucose testing, and chart reviews for HIV-specific information.
- Hypertension and diabetes were defined using established clinical criteria, and multivariable log-binomial regression was used to identify predictors of hypertension.
Main Results:
- Nearly a quarter (23%) of participants had hypertension, with only 42% previously diagnosed and 17% of those on medication achieving controlled blood pressure.
- Six percent of participants met the criteria for diabetes, with half diagnosed and 36% of those on treatment having normal glucose levels.
- Age was the sole significant independent predictor of hypertension (Risk Ratio: 1.04; 95% CI: 1.03-1.06).
Conclusions:
- Hypertension and diabetes are highly prevalent among ART-experienced PWH in South Africa, with a significant proportion undiagnosed or inadequately treated.
- Hypertension was associated with age, but not with HIV-specific factors.
- Enhanced screening and management of CVD risk factors are essential to reduce future morbidity and mortality in this aging population.
Introduction:
People with HIV (PWH) are at increased risk for atherosclerotic cardiovascular disease (CVD). Screening for CVD risk factors is recommended but not routine in South African HIV clinics. We sought to describe the prevalence of CVD risk factors among antiretroviral treatment (ART)-experienced patients in South Africa.
Methods:
We performed a prospective, observational cross-sectional study of PWH (>21 years, excluding pregnant women) on ART in South Africa. We interviewed patients regarding CVD risk factors, and obtained two blood pressure (BP) measurements and random/fasting glucose via a point-of-care glucometer. Standardized chart reviews provided individuals' HIV-specific data. We defined hypertension as: self-reported use of antihypertensives or mean systolic BP (SBP) ≥140 mmHg or diastolic BP (DBP) ≥90 mmHg (Stage 1) or SBP ≥160 mmHg or DBP ≥100 mmHg (Stage 2). We defined diabetes as self-reported use of insulin/oral hypoglycaemics or fasting (random) glucose ≥7.0 (≥11.1) mmol. We obtained risk ratios (RR) for hypertension from a multivariable log-binomial regression model, adjusting for age, sex and diabetes.
Results:
From March 2015 to February 2016, 458 participants enrolled with median age 38 years (interquartile range (IQR) 33 to 44 years) and median CD4 466/μL (IQR 317 to 638/μL); 78% were women. Participants were on ART for a median of four years, with 33% on ART ≥6 years. Almost a quarter (106/458) met the study definition for hypertension, of whom 45/106 (42%) were previously diagnosed, 23/45 (51%) were on medication and 4/23 (17%) were controlled. Eight participants had asymptomatic hypertensive urgency (BP≥180/110 mmHg). Of the 458 participants, 26 (6%) met the study definition for diabetes, half of whom (13/26) were already diagnosed; 11/13 (85%) were on treatment, of whom 4/11 (36%) had normal glucose. Age was the only significant predictor of hypertension (RR, 1.04; 95% CI, 1.03 to 1.06, p < 0.0001) in the multivariable model.
Conclusions:
Hypertension and diabetes were prevalent among PWH prescribed ART in South Africa with less than half diagnosed, and still fewer treated and controlled. Hypertension was independently associated with age but not with HIV-specific factors. Screening for and treatment of CVD risk factors could decrease future morbidity and mortality, especially as this population ages.
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