37 / 48
SA JOURNAL OF DIABETES & VASCULAR DISEASE
RESEARCH ARTICLE
VOLUME 16 NUMBER 1 • JULY 2019
35
Cardiovascular risk factors among people living with HIV
in rural Kenya: a clinic-based study
Kenneth Juma, Roseanne Nyabera, Sylvia Mbugua, George Odinya, James Jowi, Mzee
Ngunga, David Zakus, Gerald Yonga
Correspondence to: Kenneth Juma
African Population and Health Research Center, Nairobi, Kenya; Clinical
Epidemiology Unit, School of Medicine, Makerere University, Kampala,
Uganda
e-mail:
kjuma@aphrc.orgSylvia Mbugua, George Odinya, Mzee Ngunga
Department of Medicine, Aga Khan University Hospital, Nairobi, Kenya
Roseanne Nyabera
Cardiac Programme Coordination Unit, the Mater Hospital, Nairobi, Kenya
David Zakus
Division of Clinical Public Health, Dalla Lana School of Public Health, University
of Toronto, Toronto, Canada
James Jowi
Department of Medicine, Maseno University, Kenya
Gerald Yonga
School of Medicine, University of Nairobi, Nairobi, Kenya
Previously published in
Cardiovasc J Afr
2019;
30
: 52–56
S Afr J Diabetes Vasc Dis
2019;
16
: 35–39
Abstract
Objectives:
To determine the prevalence of cardiovascular
risk factors and their association with antiretroviral therapy
(ART) among HIV-infected adults in a rural sub-county
hospital in Kenya.
Methods:
This was a descriptive survey of patient charts
characterising cardiovascular risk among adult patients (>
18 years) at Ukwala sub-county hospital between June 2013
and January 2015. Post-stratification survey weights were
applied to obtain prevalence levels. Adjusted odds ratios
(AOR) for each variable related to cardiovascular risk factors
were calculated using logistic regression models.
Results:
Overall, the prevalence of diabetes mellitus was
0.4%, 0.3% of patients had had a previous cardiovascular
event (heart attack or stroke), 40.4% had pre-hypertension,
while 10.4% had stage 1 and 2.9% stage 2 hypertension.
Up to 14% of patients had elevated non-fasting total
cholesterol levels. Factors associated with hypertension were
male gender (AOR 1.59,
p
= 0.0001), being over 40 years of
age (AOR 1.78,
p
= 0.0001) and having an increased waist
circumference (OR 2.56,
p
= 0.0014). Raised total cholesterol
was more likely in those on tenofovir disoproxil fumarate
(TDF) (AOR 2.2,
p
= 0.0042), azidothymidine (AZT) (AOR 2.5,
p
= 0.0004) and stavudine (D4T)-containing regimens (AOR
3.13,
p
= 0.0002).
Conclusions:
An elevated prevalence of undiagnosed
cardiovascular risk factors such as hypertension and raised
total cholesterol levels was found among people living
with HIV. There was an association between raised total
cholesterol and nucleoside reverse-transcriptase inhibitor
(NRTI)-based ART regimens. Our findings provide further
rationale for integrating routine cardiovascular risk-factor
screening into HIV-care services.
Keywords:
people living with HIV, cardiovascular risk factors,
antiretroviraltherapy,hypertension,diabetes,hypercholesterolaemia,
sub-Saharan Africa
With the use and effectiveness of antiretroviral therapy (ART),
people with HIV are living longer.
1
Non-AIDS events, of which
cardiovascular disease (CVD) mediated by inflammation and
atherosclerosis predominate, are becoming more prevalent.
2,3
A
meta-analysis found that people living with HIV have a significantly
higher risk for CVD when compared to HIV-negative persons.
4
This may be due to traditional cardiovascular risk factors such as
smoking and hypertension, which have been found to be increased
in some HIV-positive cohorts,
2,5
as well as ART,
6
exposure to HIV
itself or immune activation and a pro-inflammatory state induced
by HIV,
7
or a combination of these factors.
Although there are accumulating data on cardiovascular risk
factors in people living with HIV in developed countries,
3
there
are limited data from Africa. We report on the prevalence of risk
factors for CVD among HIV-infected adults enrolled in HIV care
and treatment at a sub-county hospital in Kenya, and describe the
association with ART.
Methods
This was a cross-sectional survey of patient charts characterising
cardiovascular risk among adult patients (> 18 years) at Ukwala
sub-county hospital between June 2013 and January 2015. Within
this period, individuals with HIV attending Ukwala sub-county
hospital for HIV care were screened for cardiovascular risk factors as
part of a pilot project for integration of non-communicable disease
care into HIV programmes supported by Grand Challenge Canada
(GCC).
Ethical approval for this study was obtained from the Maseno
University ethics review committee. Data used in this study were
obtained from patient charts routinely collected at the clinic, and a
written informed consent was provided before screening by each
participant while attending the HIV clinic. Confidentiality, anonymity
and privacy of all participants were guaranteed at all levels of this
study by excluding all unique identifiers for the participants.
Baseline assessment included demographic variables, risk factors
for CVD andmeasurement of body mass index (BMI), blood pressure,
non-fasting total cholesterol and random blood glucose levels.
World Health Organisation (WHO) cardiovascular risk score was
calculated for patients aged above 40 years
8
and the information
included in the patients’ medical record files. All people with HIV