Abstract:

Background: HIV-infected adults have increased lifetime cardiovascular disease (CVD) risk (mycordial infarction (MI), stroke, and sudden cardiac death) in their lifetime due to complex interaction between CVD risk factors, ART toxicity, immune activation, endothelial dysfunction and chronic inflammation inflicted by HIV infection. Despite current scientific understanding of the complex interaction of CVD and HIV, the current Framingham risk score for CVD underestimates the risk of CVD in HIV infected patients. This said, there is limited data of prevalence of carotid atherosclerosis among HV-infected ART naïve with and without traditional risk factors especially in low-middle-income countries.

Objectives; First was to determine prevalence of carotid atherosclerosis among HIV-infected outpatient adults attending BMC CTC, and, second, was to determine factors associated with carotid atherosclerosis among HIV-infected outpatients adults attending Bugando Medical Centre CTC.

Methodology: This was a hospital based cross-sectional performed among HIV-infected patients attending Bugando Medical Centre CTC clinic from October 2017 to April 2018. Demographic and HIV-related information was collected, and cardiovascular risk was assessed by using Framingham risk score. Carotid intima media thickness (CIMT) was measured by using high-resolution ultrasound by using Sonosite. M-turbo SonoCalc IMT software version 5.0 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.

Results: Of 229 patients (median [interquartile range] age, 36 [29-43] years), 174(75.9%) were females. Overall, 8/22 (3.6%) had carotid atherosclerosis: of whom 7/8 (87.5%) were ART naïve and were in a group of low risk of developing CVD as estimated by Framingham risk score, were as 1/8 (12.5%) was ART-experienced. After adjusting for confounders in the multivariate linear regression analysis, there was no factor associated with higher CIMT in our study population.

Conclusion: Overall prevalence of subclinical atherosclerosis HIV-infected adults was 3.6% among HIV-infected patients and we did not find factors associated with atherosclerosis in our study.

Recommendations: The low prevalence of subclinical atherosclerosis risk observed does not warrant routine screening for atherosclerosis in HIV-infected patients in Tanzania. Further studies with large number of participants, especially more males, should be performed as it has been observed men tend to have higher CIMT compared to females. In addition, future studies should focus on those with advanced HIV, longer duration of HIV-infection, and ART use.