Abstract:

Background: There is an increase in the double burden of infectious diseases and noncommunicable diseases in developing countries. An increase in risk factors for coronary heart disease is an important potential noncommunicable cause of morbidity and mortality among people living longer with HIV compared to HIV-negative individuals(1). This is contributed by ARVs use which causes high risk of developing metabolic effect such as hyperlipidemia, diabetes mellitus and hypertension (2). These adverse metabolic effects of ARVs when added to other traditional coronary risk factors like age, male sex, family history of premature coronary artery disease, cigarette smoking, alcohol abuse or sedentary lifestyle pose excess risk of coronary heart disease (CHD) with time.

Objectives: The main objective of this study was to determine the prevalence of coronary heart disease risk factors and estimate a ten year risk of acquiring coronary heart disease among HIV-infected adults attending Bugando Medical Centre (BMC).

Methodology: This is a cross-sectional analytical study which included three groups: HIV patients not on ARTs, HIV patients on ARTs≥ 2years, and HIV-negative controls. Study procedures included in this study were, face to face interviews using a modified version of the coded and pre- validated World Health Organization (WHO) STEPwise Approach to Surveillance (STEPs) Questionnaire and measurement of weight, height abdominal girth, blood pressure and Fasting blood sugar. Blood samples were taken for fasting lipid profile (total cholesterol, high density lipids (HDL), low density lipids (LDL)), CD4 count, and serum creatinine. Urine was also collected for microalbuminuria. Framingham CVD risk score was calculated using the equation from Framingham heart study.

Results: A total of 461 participants were enrolled. 155 were HIV-negative, 153 HIV ART naïve and 153 HIV patients on ART for ≥2 years. The median age was 39 years (33-46). Most of participants were female (66.16%) and median duration of ARTs was 56 months [32-70]. Prevalence of risk factors for coronary heart disease in HIV-infected patients on ARTs for ≥2 years was higher compared to other groups. Hypertension was important risk factors (32.03%), vs (19.2%) in the control, being predicted by old age, current CD4, use of any ART and use of PIs. The overall 10 years predicted CHD risk was increased in HIV infected on ART group with median 2.1 [1.1-3.7] compared to ART naïve 1.1 [0.6-2.8] and control 1.5 [0.8-3.9]. However, there was no significant difference in prevalence of moderate risk (>10%) in the ART group (7.2%) compared to HIV ART naïve (5.2%) and control 8.4%).

Conclusion and recommendation: There is an increased prevalence of risk factors for coronary heart disease among HIV patients on ARTS attending HIV clinic at BMC. Hypertension appears to be the most important of all the risk factors. A ten year prediction for coronary heart disease risk also suggest an overall increased trend. We recommend a public health approach to HIV-infected adults that gives more attention not only the HIV-infection but also to cardiovascular risk factors. In particular hypertension which appears to be highly prevalent and screening of which is simple.