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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 30, No 6, November/December 2019
352
AFRICA
A 10-year follow-up study of demographic and
cardiometabolic factors in HIV-infected South Africans
Edith Phalane, Carla Maria Theresia Fourie, Catharina Martha Cornelia Mels, Aletta Elisabeth Schutte
Abstract
Objectives:
Understanding of the interplay between human
immunodeficiency virus (HIV) and cardiovascular disease,
especially in Africa, is limited to evidence from longitudi-
nal studies. Therefore the demographic profile and cardio-
metabolic, renal and liver function of an HIV-infected South
African population were profiled from 2005 to 2015.
Methods:
The study included 117 HIV-infected and 131
uninfected controls that were examined at baseline, five and
10 years.
Results:
Mortality rate declined from 24% (2005–2010) to
0% (2010–2015) after the introduction of ART. Longitudinal
increases in C-reactive protein (
p
=
0.002), alanine transami-
nase (
p
=
0.006) and gamma-glutamyl transferase (
p
=
0.046)
levels and estimated glomerular filtration rate (
p
<
0.001) were
seen only in the HIV-infected group. This group also showed
increased high-density lipoprotein cholesterol (HDL-C) (
p
<
0.001) and total cholesterol (
p
<
0.001) levels and decreased
triglyceride:HDL-C (
p
=
0.011) levels. Low-density lipopro-
tein cholesterol decreased in both groups (
p
<
0.001).
Conclusion:
Despite trajectories of deranged lipid and inflam-
matory profiles, the cardiometabolic disease risk seems stable
in HIV-infected South Africans. Inflammation and renal and
liver function warrant regular monitoring.
Keywords:
human immunodeficiency virus, antiretroviral thera-
py, cardiometabolic factors, renal function, liver enzymes, South
Africa
Submitted 13/11/18, accepted 24/5/19
Published online 2/8/19
Cardiovasc J Afr
2019;
30
: 352–360
www.cvja.co.zaDOI: 10.5830/CVJA-2019-034
Since the discovery of the human immunodeficiency virus
(HIV) in the 1980s,
1
the global prevalence of HIV infection
has increased from 7.6 million patients in 1990 to 36.7 million
in 2017.
2
Of global infections, eastern and southern Africa
contributed 53% of new infections and include 19.6 million
people living with HIV in these regions.
2
The HIV epidemic in South Africa received significant
attention during the 1990s, due to the growing incidence of
HIV infection and deaths related to acquired immunodeficiency
syndrome (AIDS).
3
In order to address the growing burden
of HIV/AIDS, the South African government implemented
the antiretroviral therapy (ART) roll-out programme for
HIV-infected patients in April 2004,
4
which is now the world’s
largest ART roll-out programme.
5
The use of ART has improved
the life expectancy of people infected with HIV in a country
that has seen a dramatic increase in the number of HIV-infected
patients, namely 11.5% (5.35 million) in 2005 to 12.5% (6.19
million) in 2015 (Fig. 1) and 12.6% (7.1 million) in 2017.
6
Despite
various campaigns to reduce HIV infection rates, South Africa
continues to bear a disproportionate share of the global burden
of HIV, as the highest rates of new HIV infection are still
reported in South Africa.
2
The era of ART has exposed new challenges, including
cardiometabolic changes such as elevated blood pressure,
7
dyslipidaemia,
7
lipodystrophy
8
and chronic inflammation,
9
which
are all associated with increased development of cardiovascular
disease (CVD). The use of ART is associated with hepatotoxicity,
which often manifests as liver disease in HIV-infected patients.
10
In addition, renal disease, characterised by higher urinary
protein excretion and elevated serum creatinine, was observed in
HIV-infected individuals.
11
With 56%of the HIV-infected patients
on ART in South Africa,
5
the prevalence of cardiometabolic and
renal diseases in HIV-infected patients has increased.
12
The HIV-infected population is at a higher risk of developing
CVD due to the complex interlinkage between HIV, ART and
cardiometabolic disease.
13
Furthermore, sub-Saharan Africa is
faced with co-epidemics of HIV infection and CVD.
14
Further
research is required to understand the nexus between these
conditions, and limited evidence is available from longitudinal
studies in Africa.
In a cross-sectional analysis of 300 newly diagnosed
HIV-infected, ART-naïve individuals individually matched with
uninfected controls by age, gender, body mass index (BMI) and
locality, we previously reported dyslipidaemia and inflammation
in the HIV-infected group, which suggested increased risk for
the development of CVD.
15
In this study, HIV-infected black
Africans and controls were followed over 10 years to profile the
demographic factors and to investigate the impact of long-term
HIV infection and ART use on cardiometabolic factors, as well
as liver and renal function.
Methods
This study is embedded within the Prospective Urban and
Rural Epidemiology (PURE) study, which is a multinational
Hypertension in Africa Research Team (HART), North-West
University, Potchefstroom, South Africa
Edith Phalane, MHSc
Carla Maria Theresia Fourie, PhD,
carla.fourie@nwu.ac.zaCatharina Martha Cornelia Mels, PhD
Aletta Elisabeth Schutte, PhD
Medical Research Council Unit for Hypertension and
Cardiovascular Disease, Faculty of Health Sciences, North-
West University, Potchefstroom, South Africa
Carla Maria Theresia Fourie, PhD
Catharina Martha Cornelia Mels, PhD
Aletta Elisabeth Schutte, PhD