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Epidemiology of Coronary Atherosclerosis Among People Living With HIV in Uganda : A Cross-Sectional Study
Mark J Siedner1, Brian Ghoshhajra2, Geoffrey Erem3
1Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Mbarara University of Science and Technology, Mbarara, Uganda; Africa Health Research Institute, KwaZulu-Natal, South Africa; and University of KwaZulu-Natal, Durban, South Africa (M.J.S.).
Insights
Coronary atherosclerotic disease (CAD) prevalence is low in Uganda, with no significant difference found between people living with HIV (PWH) and people without HIV (PWoH). These findings suggest CAD may not be a major health concern in this region.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Data on coronary atherosclerotic disease (CAD) prevalence in the African region, particularly concerning people with and without HIV, is limited.
- Understanding CAD burden in diverse populations is crucial for global cardiovascular health strategies.
Purpose of the Study:
- To estimate the prevalence of CAD in Uganda.
- To investigate the association between well-controlled HIV infection and the presence or severity of CAD.
Main Methods:
- A cross-sectional study was conducted in Southwestern Uganda.
- Participants included ambulatory people living with HIV (PWH) on antiretroviral therapy and age/sex-matched people without HIV (PWoH).
- Cardiovascular disease risk profiling and computed tomography scanning were used to detect CAD.
Main Results:
- The overall prevalence of CAD was low (7.7%) among 586 participants.
- CAD prevalence was similar between PWH (9.1%) and PWoH (6.4%), with no significant difference after adjusting for cardiovascular risk factors.
- Most PWH (95%) were virologically suppressed, and both groups had comparable CVD risk profiles.
Conclusions:
- CAD prevalence in Uganda is low compared to Global North cohorts with similar risk profiles.
- HIV serostatus did not appear to be associated with increased CAD prevalence in this cohort.
- CAD may not be a primary cause of morbidity in Uganda, warranting further investigation in diverse populations.
Background:
Data on the prevalence of coronary atherosclerotic disease (CAD) in the African region among people with and without HIV are lacking.
Objective:
To estimate the prevalence of CAD in Uganda and determine whether well-controlled HIV infection is associated with increased presence or severity of CAD.
Design:
Cross-sectional study.
Setting:
Southwestern Uganda.
Participants:
Ambulatory people living with HIV (PWH), aged older than 40 years, taking antiretroviral therapy for 3 or more years, and population-based, age- and sex-similar people without HIV (PWoH).
Measurements:
Participants had cardiovascular (CV) disease (CVD) risk profiling and computed tomography scanning for detection of CAD, defined as the presence of calcified or noncalcified plaque.
Results:
Of 630 screened, 586 (93%) met criteria and had evaluable images. Of these, 287 (49.0%) were PWH and nearly all (272 of 287 [95%]) were virologically suppressed. Mean age (57.9 vs. 57.4 years), proportion female (49%), and median CVD risk score (4.1 vs. 3.4) did not differ by HIV serostatus. The prevalence of CAD was low overall (45 of 586 [7.7%]) and among both PWH (26 of 287 [9.1%]) and PWoH (19 of 299 [6.4%]; absolute prevalence difference, 2.7% [95% CI, -1.6% to 7.0%]). Results were similar after adjustment for CVD risk factors.
Limitations:
Our findings may not generalize to symptomatic populations or those with greater predicted CVD risk. The study was not powered to detect small differences in CAD prevalence between HIV subgroups. Both PWH and PWoH had similar CV risk factor profiles, but residual confounding between HIV and CAD cannot be excluded.
Conclusion:
The prevalence of CAD in Uganda was low compared with population-based cohorts from the Global North with similar CVD risk profiles and was similar between HIV serostatus subgroups. Our results suggest that CAD may not be a major cause of morbidity in Uganda.
Primary Funding Source:
National Institutes of Health.
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