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Association of predicted 10 years cardiovascular mortality risk with duration of HIV infection and antiretroviral therapy among HIV-infected individuals in Durban, South Africa.

ABSTRACT: Background:South Africa has the largest population of human immunodeficiency virus (HIV) infected patients on antiretroviral therapy (ART) realising the benefits of increased life expectancy. However, this population may be susceptible to cardiovascular disease (CVD) development, due to the chronic consequences of a lifestyle-related combination of risk factors, HIV infection and ART. We predicted a 10-year cardiovascular mortality risk in an HIV-infected population on long-term ART, based on their observed metabolic risk factor profile. Methods:We extracted data from hospital medical charts for 384 randomly selected HIV-infected patients aged ??30 years. We defined metabolic syndrome (MetS) subcomponents using the International Diabetes Federation definition. A validated non-laboratory-based model for predicting a 10-year CVD mortality risk was applied and categorised into five levels, with the thresholds ranging from very low-risk (?30%). Results:Among the 384 patients, with a mean (± standard deviation) age of 42.90?±?8.20 years, the proportion of patients that were overweight/obese was 53.3%, where 50.9% had low high-density lipoprotein (HDL) cholesterol and 21 (17.5%) had metabolic syndrome. A total of 144 patients with complete data allowed a definitive prediction of a 10-year CVD mortality risk. 52% (95% CI 44-60) of the patients were stratified to very low risk (?30%) of 10-year CVD mortality. The CVD risk grows with increasing age (years), 57.82?±?6.27 among very high risk and 37.52?±?4.50; p?

SUBMITTER: Todowede OO

PROVIDER: S-EPMC6916025 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Association of predicted 10 years cardiovascular mortality risk with duration of HIV infection and antiretroviral therapy among HIV-infected individuals in Durban, South Africa.

Todowede Olamide O OO Sartorius Benn B Magula Nombulelo N Schutte Aletta E AE

Diabetology & metabolic syndrome 20191216

<h4>Background</h4>South Africa has the largest population of human immunodeficiency virus (HIV) infected patients on antiretroviral therapy (ART) realising the benefits of increased life expectancy. However, this population may be susceptible to cardiovascular disease (CVD) development, due to the chronic consequences of a lifestyle-related combination of risk factors, HIV infection and ART. We predicted a 10-year cardiovascular mortality risk in an HIV-infected population on long-term ART, bas ...[more]

PMID: 31890039

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Project description:BACKGROUND:Little is known about the clinical presentation and outcomes amongst older HIV infected populations accessing ART in sub-Saharan Africa. We compared mortality amongst HIV infected patients accessing ART that were?<? 50 years to those ?50 years in Kwa-Zulu Natal, South Africa. METHODS:We undertook a retrospective review of medical records of patients that accessed HIV services at the CAPRISA AIDS Treatment program (CAT) between June 2004 to December 2012 (N?=?4003). HIV infected patients, 14 years or older were enrolled. All-cause mortality and treatment response to ART in those <?50 years to those ?50 years were compared. A Kaplan-Meier curve and log-rank test were used to compare the cumulative probability of death between the two age groups with the primary endpoint being mortality. Statistical analysis was done using SAS (version 9.4.; SAS Institute Inc., Cary, NC, USA). RESULTS:Of 4003 individuals, 262 (6.5%) were???50 years (older group). The median age in those ?50 years and?<? 50 year was 54.5 and 32.0 years, respectively. The younger group was mainly female (64.7%). There was no difference in mortality rate, between the older (6.9/100 person-years (py), 95% confidence interval (CI): 4.7-9.6) and younger group (5.3/100 py, 95% CI: 4.7-5.8) at 60 months (p?=?0.137). In the multivariable model older patients had a significantly higher risk of death compared to younger patients. (hazard ratio (HR) 1.60, 95% CI: 1.08-2.39, p?=?0.019).The rate of CD4+ cell count increase was higher in those <?50 years (??=?0.34, 95% CI: 0.19-0.50, p?<?0.001) with no difference in viral suppression. The older group showed significantly higher prevalence of diabetes (6.3%) and hypertension (21.5%), p?<?0.001. CONCLUSION:ART initiation in older HIV infected patients was associated with a higher mortality compared to those younger than 50 years. ART immunological response was less robust in older individuals. The increase in hypertension and diabetes among older patients suggests the need to restructure and integrate primary and specialized health care services into ART services.

Dataset Information

Association of predicted 10 years cardiovascular mortality risk with duration of HIV infection and antiretroviral therapy among HIV-infected individuals in Durban, South Africa.

Publications

Association of predicted 10 years cardiovascular mortality risk with duration of HIV infection and antiretroviral therapy among HIV-infected individuals in Durban, South Africa.

Similar Datasets

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