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Cardiovascular risk factors among ART-experienced people with HIV in South Africa

Study on prevalence, care cascade, and associations of CVD risk factors among ART-experienced people with HIV in South Africa. Identifies common factors and low rates of diagnosis and treatment. Calls for improved integration of CVD risk screening in HIV care.

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Cardiovascular risk factors among ART-experienced people with HIV in South Africa

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  1. Cardiovascular risk factors among ART-experienced people with HIV in South Africa Emily P. Hyle, MD MSc Assistant Professor of Medicine Harvard Medical School This work was supported by the National Institutes of Health (K01 HL123349) and Harvard University Center for AIDS Research (HU CFAR) NIH/NIAID (P30 AI060354)

  2. Disclosures • I am an author at UpToDate.com

  3. Background • As more PWH are prescribed ART and achieve near-normal life expectancies, non-communicable diseases (NCDs) are likely to cause more morbidity and mortality • NCD screening and management within the HIV care continuum is critical to sustain the survival benefits achieved with ART • Cardiovascular disease (CVD) risk factors, such as hypertension, diabetes, tobacco use, and obesity are amenable to screening and treatment

  4. Study Objectives • Among ART-experienced PWH in South Africa, we sought: • To characterize the prevalence of CVD risk factors • To describe the care cascade for hypertension and diabetes • To assess for an association of prevalent hypertension and diabetes with HIV-specific and CVD-specific factors

  5. Methods • Observational cross-sectional study among PWH receiving ART at a local community health center providing HIV, TB, and family planning services near Cape Town, South Africa • Eligibility criteria: • PWH who are currently prescribed ART • Older than 21 years • Not pregnant

  6. Study Design Interview Data Collection • Interviews in English or Xhosa • Standardized form about self-reported CVD risk factors and prior diagnosis and treatment of hypertension or diabetes • Measurements taken: • Blood pressure x2 • Blood glucose • From clinical charts: • Weight • Height • HIV-specific characteristics

  7. Definitions • Hypertension • Self-reported use of antihypertensive medications • OR • Mean blood pressure as measured at the interview: • SBP ≥140 mmHg • DBP ≥ 90 mmHg • Diabetes • Self-reported use of insulin or oral hypoglycemic medications • OR • Blood glucose as measured at the interview: • ≥7.0 mmol/L (fasting) • ≥11.1 mmol/L (random)

  8. Statistical Analysis • We performed multivariable log-binomial regression to identify associations with hypertension (or diabetes) and considered the following covariates: • Age, sex, current CD4, nadir CD4, total time on ART, type of ART, diabetes (or hypertension), and current tobacco use

  9. Study Enrollment and Participation Enrolled and interviewed n=466 • Excluded: • No chart review (n=6) • Not on ART (n=2) Glucose and BP measurement n=458 People with diabetes n=26 Neither n=333 People with hypertension n=106 People with hypertension and diabetes n=7

  10. Demographics *Data are missing for time on ART (31 participants) and adherence (150 participants)

  11. CVD Risk Factors *Data are missing for BMI (175 participants)

  12. Results

  13. Existing Care Cascade among PWH on ART

  14. Multivariable Analysis • For every additional year of age, there was a 4% increase in the relative risk of having hypertension • No other parameters were significantly associated with hypertension, including sex • Due to small sample size, we were unable to perform regression on associations of diabetes with HIV- and CVD-specific factors

  15. Limitations • Some data were not available (lipids; HIV RNA) or were frequently missing (weight; height) • We could not obtain multiple measurements on different days to confirm a formal diagnosis of hypertension or diabetes • The study population was a convenience sample from 1,700 patients at this clinic that was older and more female than clinic demographics • Results from this single site might not be generalizable to other settings within South Africa or sub-Saharan Africa

  16. Conclusions • Hypertension, diabetes, obesity, and smoking were common among highly adherent, ART-experienced PWH at a community health clinic in South Africa • Existing cascades of clinical care show low rates of diagnosis, treatment, and control of hypertension and diabetes among PWH • Opportunities to integrate CVD risk factor screening and linkage into clinical care for PWH should be pursued to improve CVD risk reduction

  17. Thank You Dr. Linda-Gail Bekker Emily B Martey Dr. Mingshu Huang AiXu Dr. Robert A Parker Dr. Rochelle P Walensky Dr. Keren Middelkoop • Study participants • Heidi Freislich • Alicia Letago • NokukanyaTiyane • Maria Jose Acosta Robayo Supported by: National Institutes of Health (K01 HL123349) Harvard University Center for AIDS Research (HU-CFAR) (NIH/NIAID P30 AI060354)

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