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Carotid Intima Media Thickness in Mainly Female HIV-Infected Subjects in Rural South Africa: Association With Cardiovascular but Not HIV-Related Factors.
Clin Infect Dis 2015; 61(10):1606-14CI

Abstract

BACKGROUND

In sub-Saharan Africa, the number of persons living with human immunodeficiency virus (HIV) has increased immensely. In parallel, rates of noncommunicable diseases, especially cardiovascular disease, are rising rapidly in resource-limited settings. This study aims to evaluate the relation between subclinical atherosclerosis and HIV-related and traditional cardiovascular risk factors in HIV-infected patients in rural South Africa.

METHODS

A cross-sectional study was performed among HIV-infected patients visiting a health center in Limpopo, South Africa. Demographic and HIV-related information was collected, and cardiovascular risk was assessed. Carotid intima media thickness (CIMT) was measured 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 adjusted for age and sex.

RESULTS

The median CIMT in 866 subjects (median age [interquartile range], 41 [35-48] years; 69% female) was 0.589 mm (interquartile range, 0.524-0.678 mm), and values seemed higher than in healthy Western reference populations. In fact 12% of subjects (106 of 866) had subclinical atherosclerosis. Hypertension, high body mass index, previous cardiovascular event, diabetes mellitus, total and low-density lipoprotein cholesterol, estimated glomerular filtration rate, metabolic syndrome, and the Framingham Heart Risk score were independently associated with CIMT. No HIV-related determinants were associated with CIMT.

CONCLUSIONS

In a predominantly female HIV-infected population in South Africa, CIMT values are considerably high and associated with cardiovascular risk factors, rather than HIV-related factors. This finding emphasizes the need to screen for cardiovascular disease among persons with HIV infection in resource-limited settings. Ideally, this screening would be integrated into care for chronic HIV infection, posing a major challenge for the future.

Authors+Show Affiliations

Department of Internal Medicine and Infectious Diseases.Department of ImageLabonline & Cardiovascular, Erichem, The Netherlands.Department of Ndlovu Care Group, Elandsdoorn, Limpopo, South Africa.Department of Vascular Medicine, University Medical Centre Utrecht.Department of Internal Medicine and Infectious Diseases.Department of Internal Medicine and Infectious Diseases.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26215596

Citation

Schoffelen, Annelot F., et al. "Carotid Intima Media Thickness in Mainly Female HIV-Infected Subjects in Rural South Africa: Association With Cardiovascular but Not HIV-Related Factors." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 61, no. 10, 2015, pp. 1606-14.
Schoffelen AF, de Groot E, Tempelman HA, et al. Carotid Intima Media Thickness in Mainly Female HIV-Infected Subjects in Rural South Africa: Association With Cardiovascular but Not HIV-Related Factors. Clin Infect Dis. 2015;61(10):1606-14.
Schoffelen, A. F., de Groot, E., Tempelman, H. A., Visseren, F. L., Hoepelman, A. I., & Barth, R. E. (2015). Carotid Intima Media Thickness in Mainly Female HIV-Infected Subjects in Rural South Africa: Association With Cardiovascular but Not HIV-Related Factors. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 61(10), pp. 1606-14. doi:10.1093/cid/civ586.
Schoffelen AF, et al. Carotid Intima Media Thickness in Mainly Female HIV-Infected Subjects in Rural South Africa: Association With Cardiovascular but Not HIV-Related Factors. Clin Infect Dis. 2015 Nov 15;61(10):1606-14. PubMed PMID: 26215596.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Carotid Intima Media Thickness in Mainly Female HIV-Infected Subjects in Rural South Africa: Association With Cardiovascular but Not HIV-Related Factors. AU - Schoffelen,Annelot F, AU - de Groot,Eric, AU - Tempelman,Hugo A, AU - Visseren,Frank L J, AU - Hoepelman,Andy I M, AU - Barth,Roos E, Y1 - 2015/07/27/ PY - 2015/05/15/received PY - 2015/07/08/accepted PY - 2015/7/29/entrez PY - 2015/7/29/pubmed PY - 2016/7/28/medline KW - HIV KW - atherosclerosis KW - cardiovascular risk factors KW - carotid intima media thickness KW - sub-Saharan Africa SP - 1606 EP - 14 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin. Infect. Dis. VL - 61 IS - 10 N2 - BACKGROUND: In sub-Saharan Africa, the number of persons living with human immunodeficiency virus (HIV) has increased immensely. In parallel, rates of noncommunicable diseases, especially cardiovascular disease, are rising rapidly in resource-limited settings. This study aims to evaluate the relation between subclinical atherosclerosis and HIV-related and traditional cardiovascular risk factors in HIV-infected patients in rural South Africa. METHODS: A cross-sectional study was performed among HIV-infected patients visiting a health center in Limpopo, South Africa. Demographic and HIV-related information was collected, and cardiovascular risk was assessed. Carotid intima media thickness (CIMT) was measured 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 adjusted for age and sex. RESULTS: The median CIMT in 866 subjects (median age [interquartile range], 41 [35-48] years; 69% female) was 0.589 mm (interquartile range, 0.524-0.678 mm), and values seemed higher than in healthy Western reference populations. In fact 12% of subjects (106 of 866) had subclinical atherosclerosis. Hypertension, high body mass index, previous cardiovascular event, diabetes mellitus, total and low-density lipoprotein cholesterol, estimated glomerular filtration rate, metabolic syndrome, and the Framingham Heart Risk score were independently associated with CIMT. No HIV-related determinants were associated with CIMT. CONCLUSIONS: In a predominantly female HIV-infected population in South Africa, CIMT values are considerably high and associated with cardiovascular risk factors, rather than HIV-related factors. This finding emphasizes the need to screen for cardiovascular disease among persons with HIV infection in resource-limited settings. Ideally, this screening would be integrated into care for chronic HIV infection, posing a major challenge for the future. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/26215596/Carotid_Intima_Media_Thickness_in_Mainly_Female_HIV_Infected_Subjects_in_Rural_South_Africa:_Association_With_Cardiovascular_but_Not_HIV_Related_Factors_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/civ586 DB - PRIME DP - Unbound Medicine ER -