Treated HIV Infection and Progression of Carotid Atherosclerosis in Rural Uganda: A Prospective Observational Cohort Study
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Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
Journal of the American Heart Association
Abstract
Although ≈70% of the world’s population of people living with HIV reside in sub-Saharan
Africa, there are
minimal prospective data on the contributions of HIV infection to atherosclerosis in the region.
METHODS AND RESULTS: We conducted a prospective observational cohort study of people living with HIV on antiretroviral
therapy >40 years of age in rural Uganda, along with population-based
comparators not infected with HIV. We collected data
on cardiovascular disease risk factors and carotid ultrasound measurements annually. We fitted linear mixed effects models,
adjusted for cardiovascular disease risk factors, to estimate the association between HIV serostatus and progression of
carotid intima media thickness (cIMT). We enrolled 155 people living with HIV and 154 individuals not infected with HIV and
collected cIMT images at 1045 visits during a median of 4 annual visits per participant (interquartile range 3–4,
range 1–5).
Age (median 50.9 years) and sex (49% female) were similar by HIV serostatus. At enrollment, there was no difference in mean
cIMT by HIV serostatus (0.665 versus 0.680 mm, P=0.15). In multivariable models, increasing age, blood pressure, and non–high-
density
lipoprotein cholesterol were associated with greater cIMT (P<0.05), however change in cIMT per year was also
no different by HIV serostatus (0.004 mm/year for HIV negative [95% CI, 0.001–0.007
mm], 0.006 mm/year for people living
with HIV [95% CI, 0.003–0.008
mm], HIV×time interaction P=0.25).
CONCLUSIONS: In rural Uganda, treated HIV infection was not associated with faster cIMT progression. These results do not
support classification of treated HIV infection as a risk factor for subclinical atherosclerosis progression in rural sub-Saharan
Africa.
Description
Keywords
Antiretroviral therapy, Atherosclerosis, Cardiovascular disease risk, Carotid intima media thickness, HIV infection, Uganda
Citation
Siedner, M. J., Bibangambah, P., Kim, J. H., Lankowski, A., Chang, J. L., Yang, I. T., ... & Okello, S. (2021). Treated HIV infection and progression of carotid atherosclerosis in rural Uganda: a prospective observational cohort study. Journal of the American Heart Association, 10(12), e019994.