50 / 66
CARDIOVASCULAR JOURNAL OF AFRICA • Volume 30, No 6, November/December 2019
358
AFRICA
The decrease seen in TG:HDL-C in the HIV-infected
participants over time may be attributed to the effect of the
increase in HDL-C levels.
27
These findings suggest that increased
longevity on ART provides benefits, and the low to moderate
effect of ART on CVD risk factors might be modulated by the
mean age of the participants being 52.4 ± 5.66 years at follow
up.
28
It is well documented that older age is associated with
higher CVD risk,
29
and the study participants were middle-aged,
leaving several years for the consequences of CVD to take effect.
The 10-year continued elevation in circulating CRP levels
in HIV-infected black Africans confirms the well-known
inflammatory response due to HIV infection, which is marked
by excess leukocytes and cytokines.
9
Early and effective ART
initiation plays an important role in reducing immune activation
and inflammation in HIV-infected individuals.
30
However,
findings from randomised, controlled trials reported persistently
elevated CRP levels in HIV-infected patients before and after
ART use, and CRP elevation was associated with HIV disease
progression.
31
The finding of this study supports persistent
low-grade inflammation in HIV-infected patients, even after
long-term ART, which may be a result of on-going viral
replication or microbial translocation.
32
Moreover, CRP is
associated with CVD risk and all-cause mortality not only in the
general population,
33
but also in HIV-infected patients.
9
Table 4. Change in cardiometabolic characteristics of the HIV-infected
and uninfected individuals over 10 years
HIV infected
p
-value
2005
2010
2015
Biochemical vari-
ables (
n
=
93–101)*
TC, mmol/l
4.41 ±1.24
4.57 ±0.16
4.57 ±1.03
0.31
LDL-C, mmol/l
2.58 ±0.99
2.68±1.01
2.59 ±0.90
0.45
HDL-C, mmol/l
1.18 (1.09; 1.29) 1.18 (1.10; 1.27) 1.30 (1.22; 1.39)
0.017
TG, mmol/l
1.08 (0.98; 1.19) 1.07 (0.91; 1.27) 1.15 (0.21; 1.28)
0.63
TC:HDL-C ratio 3.58 (3.32; 3.85) 3.72 (3.45; 4.02) 3.41 (3.18; 3.65)
0.003
TG:HDL-C ratio 0.91 (0.80; 1.04) 0.91 (0.76; 1.09) 0.88 (0.77; 1.01)
0.88
Glucose, mmol/l 4.61 (4.44; 4.79)
a
4.70 (4.45; 4.96)
b
5.15 (5.01; 5.28)
ab
<
0.001
HbA
1c
, %
5.48 (5.40; 5.57)
a
5.67 (5.58; 5.77)
ab
5.46 (5.37; 5.55)
b
<
0.001
CRP, mg/l
2.35 (1.69; 3.25)
ab
3.47 (2.60; 4.63)
a
4.16 (3.11; 5.58)
b
0.002
ALT, U/l
17.0 (15.3; 18.9) 19.6 (17.5; 22.0) 21.1 (18.9; 23.7)
0.006
AST, U/l
31.9 (28.5; 35.7) 28.1 (25.5; 31.0) 28.8 (26.0; 31.9)
0.11
GGT, U/l
45.9 (39.2; 53.6) 44.4 (36.8; 53.6) 53.3 (43.7; 65.0)
0.046
Renal function
Serum creatinine,
µmol/l
69.4 (65.9; 73.1)
ab
56.3 (53.8; 58.9)
a
56.1 (53.2; 59.1)
b
<
0.001
uACR, mg/mmol 0.93 (0.71; 1.23)
a
-
1.92 (1.54; 2.39)
a
<
0.001
eGFR, ml/
min/1.73 m
2
106 (100; 112)
b
122 (118; 127)
a
118 (113; 122)
ab
<
0.001
Uninfected
p
-value
2005
2010
2015
Biochemical vari-
ables (
n
=
102–113)*
TC, mmol/l
4.99 ±1.19
a
4.86 ±1.13
b
4.27 ±1.08
ab
<
0.001
LDL-C, mmol/l
2.74 ±1.09
a
2.78 ±1.10
b
2.20 ±1.33
ab
<
0.001
HDL-C, mmol/l 1.59 (1.48; 1.71)
a
1.47 (1.38; 1.57) 1.31 (1.14; 1.51)
a
0.006
TG, mmol/l
1.01 (0.94; 1.10) 1.05 (0.97; 1.13) 0.99 (0.88; 1.11)
0.58
TC:HDL-C
ratio, %
3.04 (2.84; 3.26) 3.21 (2.99; 3.44) 2.97 (2.72; 3.24)
0.007
TG:HDL-C
ratio, %
0.63 (0.57; 0.72)
a
0.71 (0.63; 0.80) 0.75 (0.66; 0.86)
a
0.023
Glucose, mmol/l 4.81 (4.65; 4.96) 4.94 (4.76; 5.12) 5.04 (4.84; 5.25)
<
0.001
HbA
1c
, %
5.48 (5.40;
5.57)
abc
5.92 (5.79;
6.06)
abc
5.65 (5.52;
5.79)
abc
<
0.001
CRP, mg/l
2.35 (1.78; 3.10) 2.72 (2.087; 3.55) 2.75 (2.10; 3.59)
0.45
ALT, U/l
18.6 (16.7; 20.9) 16.8 (15.2; 18.5) 15.0 (13.4; 16.9)
0.001
AST, U/l
29.0 (25.5; 33.1)
a
26.1 (23.5; 28.9) 23.6 (21.1; 26.4)
a
0.002
GGT, U/l
58.8 (49.3;
70.1)
abc
47.0 (38.6;
57.2)
abc
37.9 (31.1;
46.0)
abc
<
0.001
Renal function
Serum creatinine,
µmol/l
63.9 (61.7; 66.2) 59.3 (57.1; 61.5)
a
57.7 (52.9; 62.9)
a
0.027
uACR, mg/mmol 0.60 (0.48; 0.74)
a
-
1.44 (1.17; 1.77)
a
<
0.001
eGFR, ml/
min/1.73 m
2
118 (114; 122)
121 (118; 124)
116 (106; 127)
0.53
Data are presented as mean and SD for normally distributed variables and for loga-
rithmically transformed variables as geographic mean and 5th and 95th percentile.
Means with same superscript differ significantly (
p
<
0.05).
*Data available for all three data collection time points were less than those for 2005
to 2015. SD, standard deviation; HIV, human immunodeficiency virus;
n
, number
of participants; 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 5. Percentage of cardiometabolic risk factors exceeding specific
cut-offs of the HIV-infected and uninfected individuals over 10 years
Cardiometabolic factors
2005 baseline study
HIV
infected
n
=
320
HIV
uninfected
n
=
320
p
-value
WC,
n
(%)
Women ≥ 94 cm
16/198 (8.0)
19/194 (10)
0.55
Men ≥ 80 cm
17/117 (15)
17/116 (15)
0.98
Blood pressure ≥ 130/85 mmHg,
n
(%)
105/320
(32.8)
136/320
(42.5)
0.011
Glucose ≥ 5.6 mmol/l,
n
(%)
35/301 (12)
47/307 (15)
0.18
HDL-C,
n
(%)
Women
≤
1.29 mmol/l
34/124 (27.4) 50/161 (31)
0.504
Men
≤
1.03 mmol/l
48/125 (38)
21/108 (19)
0.016
TG ≥ 1.7 mmol/l,
n
(%)
55/313 (18)
48/318 (15)
0.40
2010 follow-up study
n
=
163
n
=
192
WC,
n
(%)
Women ≥ 94 cm
6/114 (5)
21/117 (18)
0.003
Men ≥ 80 cm
9/47 (19)
12/71 (17)
0.75
Blood pressure ≥ 130/85 mmHg,
n
(%) 58/160 (36)
87/185 (47)
0.043
Glucose ≥ 5.6 mmol/l,
n
(%)
14/161 (9)
27/184 (15)
0.087
HDL-C,
n
(%)
Women
≤
1.29 mmol/l
44/115 (38)
66/113 (58)
0.002
Men
≤
1.03 mmol/l
33/44 (75)
59/66 (89)
0.046
TG ≥ 1.7 mmol/l,
n
(%)
42/162 (26)
38/192 (20)
0.18
2015 follow-up study
n
=
117
n
=
131
WC,
n
(%)
Women ≥ 94 cm
18/73 (25)
36/95 (38)
0.504
Men ≥ 80 cm
11/25 (44)
17/53 (32)
0.31
Blood pressure ≥ 130/85 mmHg,
n
(%) 42/117 (36)
61/131 (47)
0.088
Glucose ≥ 5.6 mmol/l,
n
(%)
23/104 (22)
32/120 (27)
0.43
HDL-C,
n
(%)
Women
≤
1.29 mmol/l
39/83 (47)
30/77 (39)
0.31
Men
≤
1.03 mmol/l
17/23 (75)
41/49 (84)
0.33
TG ≥ 1.7 mmol/l,
n
(%)
20/92 (22)
19/141 (13)
0.098
Data are presented as proportion and percentage.
HIV, human immunodeficiency virus;
n
, number of participants; WC, waist
circumference; HDL-C, high-density lipoprotein cholesterol; TG, triglycerides.
The cardiometabolic factors were defined using the International Diabetes
Federation (IDF) definition as follows: central obesity: men ≥ 94 cm and women
≥ 80 cm; hyperglycaemia: fasting plasma glucose ≥ 5.6 mmol/l or previously
diagnosed with type 2 diabetes; dyslipidaemia ≥ 1.7 mmol/l or specific treat-
ment; dyslipidaemia (second criteria), HDL-C men
<
1.03 mmol/l and women
<
1.29 mmol/l or specific treatment; raised blood pressure ≥ 130 mmHg systolic or
≥ 85 mmHg diastolic blood pressure or on treatment.