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Coronary artery calcium, HIV and inflammation in Uganda compared with the USA.
Open Heart 2019; 6(1):e001046OH

Abstract

Objectives

To compare the prevalence of detectable coronary artery calcium (CAC) among higher risk, older people living with HIV (PLWH) and uninfected persons in Uganda versus the USA, and second to explore associations of CAC with HIV-specific variables and biomarkers of inflammation.

Methods

This cross-sectional study of 430 total subjects compared 100 PLWH on antiretroviral therapy and 100 age-matched and sex-matched HIV-uninfected controls in Uganda with 167 PLWH on antiretroviral therapy and 63 uninfected controls in the USA. Multivariable logistic regression was used to examine associations with detectable CAC (CAC >0).

Results

Compared with US subjects, Ugandans were older (mean age 56 vs 52 years) and were more likely to have diabetes (36% vs 3%) and hypertension (85% vs 36%), but were less likely to be male (38% vs 74%) or smokers (4% vs 56%). After adjustment for HIV serostatus, age, sex and traditional risk factors, Ugandans had substantially lower odds of CAC >0 (adjusted OR 0.07 (95% CI 0.03 to 0.17), p<0.001). HIV was not associated with CAC >0 in either country (p>0.1). Among all PLWH, nadir CD4 count was associated with the presence of CAC, and among Ugandans soluble intercellular adhesion molecule (p=0.044), soluble CD163 (p=0.004) and oxidised low-density lipoprotein (p=0.043) were all associated with the presence of CAC.

Conclusions

Ugandans had a dramatically lower prevalence of any coronary calcification compared with US subjects. The role of HIV infection and inflammation as risk factors for subclinical coronary disease in sub-Saharan Africa merits further investigation.

Authors+Show Affiliations

Medicine and Pediatrics, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.Radiology, St Francis Hospital Nsambya, Kampala, Uganda. Radiology and Medicine, Makerere University College of Health Sciences, Kampala, Uganda.HIV Medicine, Joint Clinical Research Centre, Kampala, Uganda.Radiology and Medicine, Makerere University College of Health Sciences, Kampala, Uganda. Cardiology, Uganda Heart Institute, Kampala, Uganda.Radiology, Mackay Memorial Hospital, Taipei, Taiwan.Cardiology, Mackay Memorial Hospital, Taipei, Taiwan.Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA. Medicine, Harvard Medical School, Boston, Massachusetts, USA.Division of Internal Medicine, University Hospital, Sao Paulo, Brazil.HIV Medicine, Joint Clinical Research Centre, Kampala, Uganda.Medicine and Pediatrics, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA. Pediatric Infectious Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.Cardiology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31218009

Citation

Alencherry, Ben, et al. "Coronary Artery Calcium, HIV and Inflammation in Uganda Compared With the USA." Open Heart, vol. 6, no. 1, 2019, pp. e001046.
Alencherry B, Erem G, Mirembe G, et al. Coronary artery calcium, HIV and inflammation in Uganda compared with the USA. Open Heart. 2019;6(1):e001046.
Alencherry, B., Erem, G., Mirembe, G., Ssinabulya, I., Yun, C. H., Hung, C. L., ... Longenecker, C. T. (2019). Coronary artery calcium, HIV and inflammation in Uganda compared with the USA. Open Heart, 6(1), pp. e001046. doi:10.1136/openhrt-2019-001046.
Alencherry B, et al. Coronary Artery Calcium, HIV and Inflammation in Uganda Compared With the USA. Open Heart. 2019;6(1):e001046. PubMed PMID: 31218009.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Coronary artery calcium, HIV and inflammation in Uganda compared with the USA. AU - Alencherry,Ben, AU - Erem,Geoffrey, AU - Mirembe,Grace, AU - Ssinabulya,Isaac, AU - Yun,Chun-Ho, AU - Hung,Chung-Lieh, AU - Siedner,Mark J, AU - Bittencourt,Marcio, AU - Kityo,Cissy, AU - McComsey,Grace A, AU - Longenecker,Chris T, Y1 - 2019/05/22/ PY - 2019/03/07/received PY - 2019/04/11/revised PY - 2019/04/26/accepted PY - 2019/6/21/entrez PY - 2019/6/21/pubmed PY - 2019/6/21/medline KW - HIV KW - coronary artery calcium KW - inflammation KW - sub-saharan africa SP - e001046 EP - e001046 JF - Open heart JO - Open Heart VL - 6 IS - 1 N2 - Objectives: To compare the prevalence of detectable coronary artery calcium (CAC) among higher risk, older people living with HIV (PLWH) and uninfected persons in Uganda versus the USA, and second to explore associations of CAC with HIV-specific variables and biomarkers of inflammation. Methods: This cross-sectional study of 430 total subjects compared 100 PLWH on antiretroviral therapy and 100 age-matched and sex-matched HIV-uninfected controls in Uganda with 167 PLWH on antiretroviral therapy and 63 uninfected controls in the USA. Multivariable logistic regression was used to examine associations with detectable CAC (CAC >0). Results: Compared with US subjects, Ugandans were older (mean age 56 vs 52 years) and were more likely to have diabetes (36% vs 3%) and hypertension (85% vs 36%), but were less likely to be male (38% vs 74%) or smokers (4% vs 56%). After adjustment for HIV serostatus, age, sex and traditional risk factors, Ugandans had substantially lower odds of CAC >0 (adjusted OR 0.07 (95% CI 0.03 to 0.17), p<0.001). HIV was not associated with CAC >0 in either country (p>0.1). Among all PLWH, nadir CD4 count was associated with the presence of CAC, and among Ugandans soluble intercellular adhesion molecule (p=0.044), soluble CD163 (p=0.004) and oxidised low-density lipoprotein (p=0.043) were all associated with the presence of CAC. Conclusions: Ugandans had a dramatically lower prevalence of any coronary calcification compared with US subjects. The role of HIV infection and inflammation as risk factors for subclinical coronary disease in sub-Saharan Africa merits further investigation. SN - 2053-3624 UR - https://www.unboundmedicine.com/medline/citation/31218009/Coronary_artery_calcium_HIV_and_inflammation_in_Uganda_compared_with_the_USA_ L2 - http://dx.doi.org/10.1136/openhrt-2019-001046 DB - PRIME DP - Unbound Medicine ER -