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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 30, No 6, November/December 2019
AFRICA
355
In the case of a positive result, the test was confirmed with the
Pareeshak card test (BHAT Bio-tech, India), SD BIOLINE HIV
1/2 3.0 card test (Standard Diagnostics, INC, Korea) and Abon
(Biopharm Corporation Ltd, Hanyzhou, China) rapid card test
in 2005, 2010 and 2015, respectively.
The CD4 cell counts were determined by the National Health
Laboratory Services (Beckman Coulter
â
EPICS
â
Xl
TM
, Fullerton,
USA) in 2005 and 2010. In 2015 the CD4 cell count was
measured on site using finger-prick blood and a point-of-care
device, PIMA
TM
CD4 (Alere, Jena, Germany).
Statistical analysis
Statistical analyses were performed using Statistica version
13.3 (TIBCO Software Inc, Palo Alto, USA, 2017). Normally
distributed variables are presented as means with standard
deviation, while the logarithmically transformed variables are
presented as geometric means with 5th and 95th percentiles.
The variables that remained skew after log-transformation are
presented as median with 25th and 75th percentiles.
Independent
t
-tests were used to compare the means
of continuous variables, and chi-squared tests to compare
frequencies in these groups. Percentage change was calculated,
and comparison was done using the independent
t
-test between
the HIV-infected and uninfected groups. The Mann–Whitney
U
-test was used to compare percentage change of skewed
variables between these groups. Repeated measures analysis
of variance was used to determine the change in continuous
variables in these groups over time.
Results
The baseline and follow-up characteristics of the HIV-infected
and uninfected groups were compared over 10 years (Table 1).
The HIV-infected participants included fewer men (24 vs 38%)
who were younger than the uninfected subjects (baseline mean
ages 43 vs 45 years). The measurements of body composition
and blood pressure did not differ between the two groups. The
HIV-infected participants presented with lower TC (
p
<
0.001)
and HDL-C (
p
<
0.001) levels and higher TC:HDL-C (
p
=
0.003) and TG:HDL-C (
p
<
0.001) at baseline compared to the
uninfected group. At follow up the HIV-infected participants
displayed higher LDL-C (
p
=
0.038) levels and TC:HDL-C (
p
=
0.016).
Lower concentrations of HbA
1c
(
p
=
0.013) were noted after 10
years (2015) in the HIV-infected than the uninfected participants.
At follow up (2015), higher levels of CRP (
p
=
0.022) and liver
enzymes, ALT (
p
<
0.001), AST (
p
=
0.011) and GTT (
p
=
0.006) were seen in the HIV-infected group compared to their
counterparts, despite comparable levels at baseline. At baseline
the HIV-infected patients showed higher serum creatinine (
p
=
0.003) and uACR (
p
=
0.003) levels and lower eGFR (
p
=
0.001)
compared to the uninfected subjects. The mortality rate in the
HIV-infected group (Table 1) declined from 24% (2005–2010) to
0% (2010–2015).
To establish whether certain attributes could be ascribed
to lost or deceased participants during the 10-year follow up,
baseline characteristics were compared of the HIV-infected
group followed, and those lost to follow up and deceased (Table
2). The deceased HIV-infected participants were older (
p
=
0.002)
and showed higher heart rates (
p
=
0.001), lower HDL-C (
p
=
0.024) levels, higher lipid ratios (all
p
=
0.033), and HbA
1c
(
p
=
0.044), CRP (
p
<
0.001) and GGT (
p
=
0.046) levels compared to
those followed and lost to follow up.
In Table 3 the 10-year percentage change between the
HIV-infected and uninfected groups was compared. No
differences were seen in the percentage change in blood pressure
and body composition between the groups, however TC and
HDL-C levels increased in the HIV-infected group, opposed
to a decrease in the uninfected (all
p
<
0.001) group. Although
LDL-C (–1.9 vs –16%,
p
<
0.001) level decreased in both groups,
a lesser decrease was noted in the HIV-infected group. The
change in TG:HDL-C differed between the HIV-infected and
uninfected groups (–8.1 vs 21%,
p
=
0.011).
Glucose level increased more (8.5 vs 4.7%,
p
=
0.046) while
HbA
1c
level remained the same in theHIV-infected group compared
to an increase in the uninfected group (0 vs 2.1%,
p
=
0.009). The
HIV-infected group displayed a greater increase in CRP (76 vs
0.1%,
p
=
0.047), ALT (25 vs –19%,
p
<
0.001) and GGT (12 vs
–34%,
p
<
0.001) levels compared to the uninfected group. The
HIV-infected group showed an increase in eGFR (4.8 vs –2.1%,
p
=
0.010) while in the uninfected group, eGFR declined.
The change in cardiometabolic characteristics of the
HIV-infected and uninfected participants was determined over
the three data-collection time points (Table 4). For this analysis,
fewer participants were available due to missing data for 2010
for some variables. In the HIV-infected group, TC, LDL-C and
TG:HDL-C (all
p
≤
0.88) remained the same, but HDL-C level
increased (
p
=
0.017), whereas in the uninfected group, all the
above lipids decreased over time (all
p
≥ 0.023). The HIV-infected
group showed no changes for AST (
p
=
0.11) and an increase in
ALT (
p
=
0.006) and GGT (
p
=
0.046) levels, while these markers
all decreased (all
p
≤
0.002) in the uninfected participants. In the
HIV-infected group, CRP level increased (
p
=
0.002) while in the
uninfected group it did not change (
p
=
0.45). An increase in
uACR was noted in the HIV-infected (
p
<
0.001) and uninfected
participants (
p
<
0.001), and eGFR (
p
<
0.001) increased over
time in the HIV-infected group, whereas in the uninfected
counterparts, no change was seen (
p
=
0.53).
Table 5 shows the proportion and percentage of cardiometa-
bolic risk factors of the HIV-infected and uninfected individuals
over 10 years. A smaller proportion of the HIV-infected
participants had elevated blood pressure than the uninfected
controls at both baseline (
p
=
0.011) and five years later (
p
=
0.043). At baseline, more of the HIV-infected men had elevated
HDL-C levels compared to the uninfected men (
p
=
0.016). Five
years later, the HIV-infected men and women presented with a
smaller proportion of individuals with elevated HDL-C levels
compared to the uninfected men (
p
=
0.046) and women (
p
=
0.002). A larger proportion of the uninfected women showed
central obesity at the 2010 (
p
=
0.003) and 2015 follow up (
p
=
0.022) compared to the HIV-infected women.
Discussion
With 12.7% of the PURE study participants living with HIV
after 10 years, the frequency of HIV is aligned with the national
South African prevalence (12.5%).
6
One of the aims of the Joint
United Nations Programme on HIV/AIDS (UNAIDS) is to
increase the number of HIV-infected patients on ART,
21
and