Prevalence of hypertension and cardiovascular risk factors among long‐term AIDS survivors: A report from the field

HIV infection is associated with increased risk and progression of cardiovascular disease (CVD), yet little is known about the prevalence of CVD risk factors among long‐term AIDS survivors in resource‐limited settings. Using routinely collected data, we conducted a retrospective study to describe the prevalence of CVD risk factors among a cohort of HIV‐infected patients followed for over 10 years in Port‐au Prince, Haiti. This cohort includes 910 adults who initiated antiretroviral therapy (ART) between 2003 and 2004 and remained in care between 2014 and 2016 when routine screening for CVD risk factors was implemented at a large clinic in Haiti. A total of 397 remained in care ≥10 years and received screening. At ART initiation, 59% were female, median age was 38 years (IQR 33‐44), and median CD4 count was 117 cells/mm3 (IQR 34‐201). Median follow‐up time from ART initiation was 12.1 years (IQR 11.7‐12.7). At screening, median CD4 count was 574 cells/mm3 (IQR 378‐771), and 84% (282 of 336 screened) had HIV‐1 RNA < 1000 copies/mL. Seventy‐four percent of patients had at least 1 risk factor including 58% (224/385) with hypertension, 8% (24/297) diabetes, 43% (119/275) hypercholesterolemia, 8% (20/248) active smoking, and 10% (25/245) obesity. Factors associated with hypertension were age (adjusted OR 1.06, P < .001) and weight at screening (adjusted OR 1.02, P = .019). Long‐term AIDS survivors have a high prevalence of CVD risk factors, primarily hypertension. Integration of cardiovascular screening and management into routine HIV care is needed to maximize health outcomes among aging HIV patients in resource‐limited settings.

[1]  B. Ovbiagele,et al.  Burden of subclinical carotid atherosclerosis and vascular risk factors among people living with HIV in Ghana , 2019, Journal of the Neurological Sciences.

[2]  T. Lancet GBD 2017: a fragile world , 2018, The Lancet.

[3]  A. Kengne,et al.  Prevalence, detection, treatment, and control of hypertension in human immunodeficiency virus (HIV)-infected patients attending HIV clinics in the Western Cape Province, South Africa , 2018, Medicine.

[4]  W. El-Sadr,et al.  Integrating cardiovascular disease risk factor screening into HIV services in Swaziland: lessons from an implementation science study , 2018, AIDS.

[5]  G. Bloomfield,et al.  Hypertension in HIV-Infected Adults: Novel Pathophysiologic Mechanisms , 2018, Hypertension.

[6]  J. Frantz,et al.  Health-related quality of life and associated factors in adults living with HIV in Rwanda , 2018, SAHARA J : journal of Social Aspects of HIV/AIDS Research Alliance.

[7]  M. Galvão,et al.  Systemic Arterial Hypertension in people living with HIV/AIDS: integrative review. , 2017, Revista brasileira de enfermagem.

[8]  P. Kaleebu,et al.  Cardiometabolic risk among HIV-POSITIVE Ugandan adults: prevalence, predictors and effect of long-term antiretroviral therapy , 2017, The Pan African medical journal.

[9]  M. Nyirenda,et al.  The burden of hypertension, diabetes mellitus, and cardiovascular risk factors among adult Malawians in HIV care: consequences for integrated services , 2016, BMC Public Health.

[10]  L. Hirschhorn,et al.  Preparedness of HIV care and treatment clinics for the management of concomitant non–communicable diseases: a cross–sectional survey , 2016, BMC Public Health.

[11]  J. Todd,et al.  Short-term and long-term cardiovascular risk, metabolic syndrome and HIV in Tanzania , 2016, Heart.

[12]  J. Atashili,et al.  Prevalence of Hypertension in HIV/AIDS Patients on Highly Active Antiretroviral Therapy (HAART) Compared with HAART-Naïve Patients at the Limbe Regional Hospital, Cameroon , 2016, PloS one.

[13]  W. Duffus,et al.  Incidence of primary hypertension in a population-based cohort of HIV-infected compared with non-HIV-infected persons and the effect of combined antiretroviral therapy. , 2015, Journal of the American Society of Hypertension : JASH.

[14]  M. Budoff,et al.  HIV Infection, Cardiovascular Disease Risk Factor Profile, and Risk for Acute Myocardial Infarction , 2015, Journal of acquired immune deficiency syndromes.

[15]  P. Reiss,et al.  Cross-sectional comparison of the prevalence of age-associated comorbidities and their risk factors between HIV-infected and uninfected individuals: the AGEhIV cohort study. , 2014, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[16]  M. Suthanthiran,et al.  Hypertension, kidney disease, HIV and antiretroviral therapy among Tanzanian adults: a cross-sectional study , 2014, BMC Medicine.

[17]  Jackson T. Wright,et al.  2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). , 2014, JAMA.

[18]  L. Calza,et al.  Prevalence, awareness, treatment, and control rate of hypertension in HIV-infected patients: the HIV-HY study. , 2014, American journal of hypertension.

[19]  L. Smeeth,et al.  Association of HIV and ART with cardiometabolic traits in sub-Saharan Africa: a systematic review and meta-analysis , 2013, International journal of epidemiology.

[20]  K. G. Lin,et al.  Hypertension among HIV-Infected Adults Receiving Highly Active Antiretroviral Therapy (HAART) in Malaysia , 2013, Global journal of health science.

[21]  V. Triant Cardiovascular Disease and HIV Infection , 2013, Current HIV/AIDS Reports.

[22]  M. Sani,et al.  Cardiovascular disease risk factors among HIV-infected Nigerians receiving highly active antiretroviral therapy , 2013, Nigerian medical journal : journal of the Nigeria Medical Association.

[23]  M. Trøseid,et al.  Low Nadir CD4 Cell Count Predicts Sustained Hypertension in HIV‐Infected Individuals , 2013, Journal of clinical hypertension.

[24]  E. Sobngwi,et al.  Fasting blood glucose and insulin sensitivity are unaffected by HAART duration in Cameroonians receiving first-line antiretroviral treatment. , 2012, Diabetes & metabolism.

[25]  W. El-Sadr,et al.  Strengthening Health Systems for Chronic Care: Leveraging HIV Programs to Support Diabetes Services in Ethiopia and Swaziland , 2012, Journal of tropical medicine.

[26]  K. Steyn,et al.  Chronic noncommunicable diseases and HIV-AIDS on a collision course: relevance for health care delivery, particularly in low-resource settings--insights from South Africa. , 2011, The American journal of clinical nutrition.

[27]  J. V. van Oosterhout,et al.  Cardiovascular risk factors in adult Malawians on long-term antiretroviral therapy. , 2011, Transactions of the Royal Society of Tropical Medicine and Hygiene.

[28]  G. Bloomfield,et al.  Hypertension and Obesity as Cardiovascular Risk Factors among HIV Seropositive Patients in Western Kenya , 2011, PloS one.

[29]  Patrick Royston,et al.  Multiple imputation using chained equations: Issues and guidance for practice , 2011, Statistics in medicine.

[30]  R. Ximenes,et al.  Profile of patients with hypertension included in a cohort with HIV/AIDS in the state of Pernambuco, Brazil. , 2010, Arquivos brasileiros de cardiologia.

[31]  C. Agyemang,et al.  Tackling Africa's chronic disease burden: from the local to the global , 2010, Globalization and health.

[32]  D. Jannat-Khah,et al.  10-Year Survival of Patients with AIDS Receiving Antiretroviral Therapy in Haiti. , 2009, The New England journal of medicine.

[33]  Mathieu Nacher,et al.  Risk factors for high blood pressure among HIV patients in French Guiana. , 2008, Journal of acquired immune deficiency syndromes.

[34]  Hang Lee,et al.  Increased acute myocardial infarction rates and cardiovascular risk factors among patients with human immunodeficiency virus disease. , 2007, The Journal of clinical endocrinology and metabolism.

[35]  E. Castells,et al.  Impact of highly active antiretroviral therapy on blood pressure in HIV‐infected patients. A prospective study in a cohort of naive patients , 2006, HIV medicine.

[36]  P. Wright,et al.  Antiretroviral therapy in a thousand patients with AIDS in Haiti. , 2005, The New England journal of medicine.

[37]  M. Lederman,et al.  Age-related immune dysfunction in health and in human immunodeficiency virus (HIV) disease: association of age and HIV infection with naive CD8+ cell depletion, reduced expression of CD28 on CD8+ cells, and reduced thymic volumes. , 2003, The Journal of infectious diseases.

[38]  Jeani Chang,et al.  Hypocholesterolemia is associated with immune dysfunction in early human immunodeficiency virus-1 infection. , 1993, The American journal of medicine.

[39]  C. Dolea,et al.  World Health Organization , 1949, International Organization.

[40]  Gundo Weiler,et al.  Global Update on HIV Treatment 2013: Results, Impact and Opportunities , 2013 .

[41]  Jackson T. Wright,et al.  Evidence-Based Guideline for the Management of High Blood Pressure in Adults , 2012 .

[42]  J. Pape,et al.  5-year survival of patients with AIDS receiving antiretroviral therapy in Haiti. , 2009, The New England journal of medicine.

[43]  J. Wang,et al.  Circulating interferon-alpha levels and hypertriglyceridemia in the acquired immunodeficiency syndrome. , 1991, The American journal of medicine.

[44]  Jack Wang,et al.  Circulating interferon-α levels and hypertriglyceridemia in the acquired immunodeficiency syndrome , 1991 .