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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 30, No 1, January/February 2019
52
AFRICA
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
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 calcu-
lated 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 cardio-
vascular 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 integrat-
ing routine cardiovascular risk-factor screening into HIV-care
services.
Keywords:
people living with HIV, cardiovascular risk factors,
antiretroviral therapy, hypertension, diabetes, hypercholesterol-
aemia, sub-Saharan Africa
Submitted 4/7/18, accepted 31/10/18
Published online 24/1/19
Cardiovasc J Afr
2019;
30
: 52–56
www.cvja.co.zaDOI: 10.5830/CVJA-2018-064
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 CVDwhen compared toHIV-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
African Population and Health Research Center, Nairobi,
Kenya; Clinical Epidemiology Unit, School of Medicine,
Makerere University, Kampala, Uganda
Kenneth Juma, MSc, MPH,
kjuma@aphrc.orgDepartment of Medicine, Aga Khan University Hospital,
Nairobi, Kenya
Sylvia Mbugua, MB ChB
George Odinya, BSc
Mzee Ngunga MB ChB
Cardiac Programme Coordination Unit, the Mater Hospital,
Nairobi, Kenya
Roseanne Nyabera, BSN, MPH
Division of Clinical Public Health, Dalla Lana School of
Public Health, University of Toronto, Toronto, Canada
David Zakus, MES, MSc, PhD
Department of Medicine, Maseno University, Kenya
James Jowi
School of Medicine, University of Nairobi, Nairobi, Kenya
Gerald Yonga, MB ChB, MBA