Evaluation of Cardiovascular Risk Factors in HIV/AIDS Patients Attending the Tiko Central Clinic and Cottage Hospital, Tiko, Cameroon

The introduction of highly active antiretroviral therapy (HAART) in 1995 has led to a significant fall in mortality observed in human immunodeficiency virus (HIV) infected patients and a noticeable decrease in opportunistic infections. However, metabolic complications associated with HAART and HIV increase the risk of developing a cardiovascular disease (CVD). This study was aimed at evaluating the risk factors associated with cardiovascular diseases amongst persons living with HIV. This was a hospital-based case-control study. Cases were HIV sero-positive persons on HAART for at least 6 months and controls were HIV sero-negative persons. Recruitment was consecutive and online DAD and QRISK calculators were used to determine the 5- and 10-year risk of cardiovascular events respectively. Out of 135 participants, 74 (54.8%) were females amongst which 53/75 (71.6%) were in the control group and 21/60 (28.4%) were in the cases group. The mean age of the participants was 42.04 (±9.61) years. The most common cardiovascular risk factors in both the cases and control groups were decreased High Density Lipoprotein cholesterol HDL-c (84.4%), insufficient fruit or vegetable consumption (68.9%), and obesity or overweight (45.9%). A lower proportion of participants, 75% (39/52) in the HAART regimen class, Tenofovir/Lamivudine/Efavirenz were at low CVD risk based on the D.A.D risk calculator compared to 78% (14/18) of those in the Zidovudine/Lamivudine /Nevirapine class. Also, more participants (23%) on Tenofovir/Lamivudine/Efavirenz were at moderate risk compared to those (22%) on Zidovudine/Lamivudine/Nevirapine. Using the QRISK®2-2016 equation, 6.7% (5/75) of HAART, HIV patients had a moderate CVD risk unlike in the control group where 13.3% (8/60) of the participants had a moderate CVD risk. On the contrary, the DAD risk equation revealed 25.3% of HAART HIV patients had a moderate CVD risk. DAD risk was higher in HIV patients who have been on HAART for more than 5 years. High Density Lipoprotein cholesterol, abnormal waist to hip ratio, abdominal obesity, obesity, and older age are more prevalent in HIV sero-positive individuals on HAART than in HIV sero-negative people. The DAD risk calculator is a suitable predictor of cardiovascular disease for HIV patients on HAART. Risk of coronary heart disease increases and is higher with Tenofovir/ Lamivudine/Efavirenz HAART regimen and with being on HAART for more than 60 months respectively.

Keywords:Cardiovascular disease; HAART; HIV risk equations; Risk factors

Abbreviations: 3TC: Lamivudine; Ab: Antibody; Ag: Antigen; AIDS: Acquired Immune Deficiency Syndrome; ART: Antiretroviral Therapy; AZT: Zidovudine; BMI: Body Mass Index; CD4+: Cluster of Differentiation ; CETP: Cholesterol Transfer Protein; CVD: Cardiovascular disease; DAD: Data collected on Adverse effects of anti-HIV Drugs; DBP: Diastolic Blood Pressure; EFV: Efavirenz; FBS: Fasting Blood Sugar; HAART: Highly; Active Antiretroviral Therapy; HC: Hip Circumference; HDL-c: High Density Lipoprotein cholesterol; HIV: Human Immunodeficiency Virus; LDL-c: Low Density Lipoprotein cholesterol; LPV: Lopinavir; NNRTIs: Non-Nucleoside Reverse Transcriptase Inhibitors ; NRTIs: Nucleoside Reverse Transcriptase Inhibitors; NVP: Nevirapine; RTV: Ritonavir; PI: Protease Inhibitor; SBP: Systolic Blood Pressure; SPSS: Statistical Package for Social Sciences; TC: Total cholesterol; TGs: Triglycerides; VLDL-c: Very Low Density Lipoprotein cholesterol; WC: Waist circumference; WHR: Waist to Hip Ratio