49 / 66
CARDIOVASCULAR JOURNAL OF AFRICA • Volume 30, No 6, November/December 2019
AFRICA
357
renal function with ART use. However, if the data are reviewed
as a trajectory towards possible future outcomes, continued
increases in eGFR may reach the hyperfiltration range, which
precedes the development of renal disease. Additionally, this
population is exposed to risk factors such as ageing, and use of
tobacco, alcohol and antihypertensive medication, which may in
the future increase their CVD risk.
24
A previous study using the PURE study population reported
dyslipidaemia in the newly diagnosed HIV-infected, ART-naïve
black Africans.
15
Now, based on the 10-year follow-up data with
85% of the HIV-infected participants on ART, this current study
reports an increase in HDL-C and TC levels and a decrease in
TG:HDL-C in the HIV-infected compared to the uninfected
controls.
In support of the increase in HDL-C levels, more of the
HIV-infected men had elevated HDL-C than their uninfected
counterparts at baseline. However, after the introduction of
ART in 2010, fewer of the HIV-infected participants presented
with lower HDL-C levels, while after 10 years, no difference was
observed. Higher HDL-C is cardioprotective, and this finding is
consistent with a study that reported an increase in HDL-C level
over 96 weeks in HIV-infected patients on a first-line regimen,
especially nevirapine (NVP).
25
The participants in this study
were using NVP (Fig. 1), which is associated with favourable
lipid changes.
26
Table 2. Baseline characteristics of HIV-infected individuals followed,
lost to follow up and deceased
Followed
n
=
117
Lost to follow
n
=
144
Deceased
n
=
77
p
-value
for trend
Sociodemograph-
ic factors
Male,
n
(%)
28 (23.9)
64 (44.4)
29 (37.7)
0.003
Urban,
n
(%)
51 (43.6)
75 (54.2)
33 (42.9)
0.14
Age, years
42.9 ± 5.64
a
43.5 ± 7.86
b
46.9 ± 10.3
ab
0.002
Anthropometry
WC, cm
74.2 (16.5; 98.0) 75.7 (64.2; 98.0) 74.6 (59.5; 99.8) 0.47
BMI, kg/m
2
22.5 (16.4; 35.6) 22.6 (17.3; 34.8) 21.0 (15.1; 32.5) 0.052
Cardiovascular
measurements
SBP, mmHg
122 (97.0; 155) 125 (98.0; 167) 119 (85.0; 166) 0.090
DBP, mmHg
84.6 ± 13.2
84.7 ± 15.3
81.8 ±16.0
0.34
PP, mmHg
37.1 (25.0; 59.0)
a
40.6 (27.0; 62.0)
a
37.3 (25.0; 66.0) 0.015
MAP, mmHg
97.5 ± 14.5
98.7 ± 17.1
97.8 ± 18.3
0.25
HR, beats/min 76.2 ± 13.1
a
74.2 ± 15.0
b
82.4 ± 18.9
ab
0.001
Biochemical
variables
TC, mmol/l
4.46 ± 1.27
4.46 ± 1.25
4.30 ± 1.31
0.62
HDL-C, mmol/l 1.19 (0.56; 2.43)
a
1.12 (0.56; 2.26) 0.97 (0.26; 2.61)
a
0.024
LDL-C, mmol/l
2.56 ± 1.04
2.65 ± 1.02
2.52 ± 10.4
0.63
TG, mmol/l
1.11 (0.52; 2.42) 1.13 (0.56; 3.03) 1.22 (0.51; 3.10) 0.45
TC/HDL-C
ratio
3.59 (1.84; 7.21)
a
3.85 (2.21; 6.51) 4.22 (1.97; 13.4)
a
0.033
TG/HDL-C
ratio
0.93 (0.30; 3.17)
a
0.99 (0.38; 4.23) 1.25 (0.51; 3.10)
a
0.033
Glucose, mmol/l 4.59 (3.30; 5.70) 4.67 (3.40; 5.90) 4.51 (3.50; 5.70) 0.38
HbA
1c
, % 5.46 (4.80; 6.20) 5.47 (4.70; 6.10) 5.62 (4.80; 6.40) 0.044
CD4 count,
cells/mm
3
314 (243; 407)
306 (240; 389)
260 (178; 379)
0.70
CRP, mg/l
2.31 (0.25; 40.9)
a
2.79 (0.31; 35.98)
b
6.48 (0.46; 53.8)
ab
<
0.001
ALT, U/l
17.5 (15.7; 19.6) 18.1 (16.3; 19.9) 18.9 (16.5; 21.8) 0.68
AST, U/l
31.5 (28.0; 35.4) 32.3 (29.1; 35.9) 36.6 (31.7; 42.2) 0.23
GGT, U/l
48.2 (17.2; 228)
a
54.6 (18.3; 320) 67.0 (20.3; 489)
a
0.046
Renal function
Serum creatinine,
µmol/l
69.2 (47.8; 101) 63.5 (44.7; 94.4) 67.9 (45.5; 114)
0.17
uACR, mg/mmol 0.92 (0.15; 16.3) 0.67 (0.14; 6.83)
a
1.19 (0.20; 32.7)
a
0.012
eGFR, ml/min/
1.73 m
2
107 (67.8; 144)
a
118 (79.8; 156)
a
108 (58.5; 143) 0.008
Lifestyle factors
Tobacco use,
n
(%)
71 (60.7)
86 (59.7)
43 (55.8)
0.79
Alcohol use,
n
(%)
53 (45.3)
69 (47.9)
40 (60.0)
0.66
Medication use
ART,
n
(%)
–
–
–
–
Antihyperten-
sive,
n
(%)
12 (10.3)
11 (7.64)
9 (11.7)
0.58
Anti-inflamma-
tory,
n
(%)
15 (12.8)
11 (7.64)
12 (15.6)
0.16
Data are presented as mean and standard deviation for normally distributed
variables and logarithmically transformed variables are presented as geographic
mean and 5th and 95th percentile. Means with same superscript differ significantly
(
p
<
0.05). HIV, human immunodeficiency virus;
n
, number of participants; WC,
waist circumference; BMI, body mass index; DBP, diastolic blood pressure; SBP,
systolic blood pressure; PP, pulse pressure, MAP, mean arterial pressure; HR,
heart rate; TC, total cholesterol; LDL-C, low-density lipoprotein cholesterol;
HDL-C, high-density lipoprotein cholesterol; HbA
1c
, glycated haemoglobin, GGT,
γ
-glutamyltransferase; CRP, C-reactive protein; AST, aspartate transaminase; ALT,
alanine transaminase; uACR, urinary albumin creatinine ratio; eGFR, estimated
glomerular filtration rate.
Table 3. Percentage change in cardiometabolic characteristics of
HIV-infected and uninfected individuals (2005–2015)
Percentage change between groups
p
-value
HIV infected
n
=
117
HIV uninfected
n
=
131
Age, %
22.4 ± 3.04
21.7 ± 3.75
0.15
Anthropometry
WC, %
9.12 (1.09; 18.7)
8.62 (1.73; 16.5)
0.80
BMI, %
3.70 ± 17.2
4.87 ± 11.2
0.53
Cardiovascular measurements
SBP, %
0.00 (–8.01; 12.2) 0.83 (–9.82; 14.6)
0.84
DBP, %
–0.17 ± 19.1
1.54 ± 18.5
0.48
PP, %
4.82 (–12.5; 33.3) 4.76 (–13.9; 30.8)
0.65
MAP, %
0.84 ± 18.0
2.17 ± 18.0
0.56
HR, %
–1.30 (–13.9; 11.0) 0.00 (–12.6; 13.1)
0.60
Biochemical variables
TC, %
6.48 (–12.2; 24.3) –14.5 (–28.8; 2.90)
<
0.001
HDL-C, %
12.7 (–20.0; 46.0) –15.1 (–31.8; 10.9)
<
0.001
LDL-C, %
–1.92 (–21.5; 33.3) –16.4 (–38.8; 2.22)
<
0.001
TG, %
2.13 (–28.6; 46.3) –1.86 (–22.0; 37.5)
0.83
TC:HDL-C ratio, %
–1.63 (–25.5; 22.1) 0.53 (–17.0; 23.1)
0.48
TG:HDL-C ratio, % –8.10 (–40.5; 54.3) 21.4 (–17.1; 86.6)
0.011
Glucose, %
8.46 (–5.85; 21.6) 4.72 (–9.56; 16.3)
0.046
HbA
1c
, %
0.01 (–5.71; 5.31) 2.12 (–1.77; 7.34)
0.009
CRP, %
75.8 (–38.1; 353)
0.08 (–52.1; 178)
0.047
ALT, %
25.4 (–15.9; 78.8) –19.3 (–42.9; 15.1)
<
0.001
AST, %
–13.6 (19.7; 139) –20.5 (–47.7; 13.4)
0.15
GGT, %
11.7 (–24.3; 68.7) –33.9 (–55.5; -3.52)
<
0.001
Renal function
Serum creatinine, % –20.4 (–34.2; –2.28) –10.8 (–26.9; 6.60) 0.033
uACR, %
106 (–36.3; 465)
132 (9.77; 365)
0.52
eGFR, %
4.83 (–5.90; 34.7) –2.09 (–9.17; 10.5) 0.010
Data are presented as mean and SD for normally distributed variables and the
variables that remained skew after log-transformation are presented as median
with 25th and 75th percentiles.
SD, standard deviation; HIV, human immunodeficiency virus;
n
, number of
participants; WC, waist circumference; BMI, body mass index; DBP, diastolic
blood pressure; SBP, systolic blood pressure; PP, pulse pressure, MAP, mean
arterial pressure; HR, heart rate; TC, total cholesterol; LDL-C, low-density lipo-
protein cholesterol; HDL-C, high-density lipoprotein cholesterol; HbA
1c
, glycated
haemoglobin; GGT,
γ
-glutamyltransferase; CRP, C-reactive protein; AST, aspar-
tate transaminase; ALT, alanine transaminase; uACR, urinary albumin creatinine
ratio; eGFR, estimated glomerular filtration rate.