HIV & cardiovascular risk in South Africans / Carla Fourie

Abstract

The human immunodeficiency virus (HIV) is a global health epidemic and South Africa (SA) is the country with the highest number of people living with HIV (PLHIV) globally. As the life expectancy of PLHIV increased, the aetiology of mortality in sub-Saharan Africa (SSA) has shifted to a combination of communicable and non-communicable diseases, such as cardiovascular disease (CVD). Due to the lack of knowledge with regards to cardiovascular risk and HIV in SA we, the Hypertension in Africa Research Team (HART), investigated the CVD risk in PLHIV. In our publications we found lower systolic blood pressure in PLHIV compared to those without HIV, while treatment was associated with normalisation of the lipid levels. This was in agreement of the literature in SSA. In untreated HIV, elevations in triglycerides and low high density lipoprotein levels predominate, which is in agreement with our findings. We observed changes in the lipid levels of PLHIV using antiretroviral treatment (ART), but no dyslipidaemia. From the literature and also from the PURE 10-year follow-up study, it is clear that ART has improved the morbidity and mortality associated with HIV. Our article on the metabolic syndrome and renal function indicated that multimorbidity may affect renal function in PLHIV and should be investigated further. This is seen in the literature where microalbuminuria has been shown to be independently associated with hypertension in PLHIV. Our research indicates that HIV itself and immune activity seem to affect vascular health. This is in agreement of that found by several studies. Although results in the literature on increased vascular ageing are controversial, our results suggest a probable protective role of ART on the vasculature. In the EndoAfrica study we observed interruption or defaulting of ART among the participants. Interrupting ART may increase inflammation and further increase the risk of CVD, and this needs to be investigated further. A limitation of our studies are the rather small study population and it does not include the South African population at large. Thus, large cohort studies which include different regions in SA are needed to confirm our findings and guide clinicians to prevent and treat CVD in PLHIV in SA.