Mark J Siedner, Brian Ghoshhajra, Geoffrey Erem, Rita Nassanga, Mangun Randhawa, Andrew Ochieng, Moses Acan, Michael T Lu, Vikas Thondapu, Angelo Takigami, Zahra Reynolds, Flavia Atwiine, Edna Tindimwebwa, Rebecca F Gilbert, Eliza Passell, Shruti Sagar, Yao Tong, Ntobeko A B Ntusi, Alexander C Tsai, Prossy Bibangambah, Thomas Gaziano, Susanne S Hoeppner, Christopher T Longenecker, Samson Okello, Stephen Asiimwe
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引用次数: 0
Abstract
Background: Data on the prevalence of coronary atherosclerotic disease (CAD) in the African region among people with and without HIV are lacking.
Objective: To estimate the prevalence of CAD in Uganda and determine whether well-controlled HIV infection is associated with increased presence or severity of CAD.
Design: Cross-sectional study.
Setting: Southwestern Uganda.
Participants: Ambulatory people living with HIV (PWH), aged older than 40 years, taking antiretroviral therapy for 3 or more years, and population-based, age- and sex-similar people without HIV (PWoH).
Measurements: Participants had cardiovascular (CV) disease (CVD) risk profiling and computed tomography scanning for detection of CAD, defined as the presence of calcified or noncalcified plaque.
Results: Of 630 screened, 586 (93%) met criteria and had evaluable images. Of these, 287 (49.0%) were PWH and nearly all (272 of 287 [95%]) were virologically suppressed. Mean age (57.9 vs. 57.4 years), proportion female (49%), and median CVD risk score (4.1 vs. 3.4) did not differ by HIV serostatus. The prevalence of CAD was low overall (45 of 586 [7.7%]) and among both PWH (26 of 287 [9.1%]) and PWoH (19 of 299 [6.4%]; absolute prevalence difference, 2.7% [95% CI, -1.6% to 7.0%]). Results were similar after adjustment for CVD risk factors.
Limitations: Our findings may not generalize to symptomatic populations or those with greater predicted CVD risk. The study was not powered to detect small differences in CAD prevalence between HIV subgroups. Both PWH and PWoH had similar CV risk factor profiles, but residual confounding between HIV and CAD cannot be excluded.
Conclusion: The prevalence of CAD in Uganda was low compared with population-based cohorts from the Global North with similar CVD risk profiles and was similar between HIV serostatus subgroups. Our results suggest that CAD may not be a major cause of morbidity in Uganda.
Primary funding source: National Institutes of Health.
期刊介绍：
Established in 1927 by the American College of Physicians (ACP), Annals of Internal Medicine is the premier internal medicine journal. Annals of Internal Medicine’s mission is to promote excellence in medicine, enable physicians and other health care professionals to be well informed members of the medical community and society, advance standards in the conduct and reporting of medical research, and contribute to improving the health of people worldwide. To achieve this mission, the journal publishes a wide variety of original research, review articles, practice guidelines, and commentary relevant to clinical practice, health care delivery, public health, health care policy, medical education, ethics, and research methodology. In addition, the journal publishes personal narratives that convey the feeling and the art of medicine.
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