Cardiovascular Disease Risk from Protease Inhibitors-ART for HIV: Retrospective Cohort of University Teaching Hospital, Zambia

Brian Chiluba; Esther Munalula-Nkandu; Chola Nakazwe Daka; Mumbi Chola; Gershom Chongwe

doi:doi:10.11648/j.ccr.20170104.11

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Cardiovascular Disease Risk from Protease Inhibitors-ART for HIV: Retrospective Cohort of University Teaching Hospital, Zambia

Brian Chiluba, Esther Munalula-Nkandu, Chola Nakazwe Daka, Mumbi Chola, Gershom Chongwe

Published in Cardiology and Cardiovascular Research (Volume 1, Issue 4)

Received: 23 July 2017 Accepted: 27 July 2017 Published: 30 August 2017

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Abstract

The burden of Cardiovascular Disease (CVD) in Sub-Saharan Africa is rising amidst a high prevalence of infectious diseases including HIV. While use of certain Antiretroviral Therapy (ART) drugs has been shown to cause dyslipidaemia, little is known about the burden of CVD in the presence of Protease Inhibitors (PIs) in Sub-Saharan Africa. We investigated the incidence and risks associated with the use of PI-containing ART in the development of CVD among HIV seropositive adults at the University Teaching Hospital, Zambia. For this purpose a retrospective cohort study was used to review records of patients on PIs and non PIs between January 2008 and January 2016. The end point of the study was CVD (n=281). Generalized linear models using a log-binomial link were used to assess covariates, while Kaplan Meier method for probability of survival to CVD and time to CVD comorbidity were utilised. The results showed that the incidence of CVD among PIs was 62%, while among the non-PI ART group it was 38%. The risk of CVD was 2.3 times higher (p<0.001; 95% CI: 1.86-2.81) in the PIs ART group than non-PI ART group. Risk factors included; Age, CD4 cell count, Type of ART, Years since HIV diagnosis and BMI, with the CVD attributable risk of 56%. The Kaplan-Meier survival estimates for CVD showed a marked difference in survivorship between the two ART groups (Log-rank P=0.003). Based on this therefore, prolonged use of PI-containing ART was significantly associated with a higher incidence of CVD. Addressing the modifiable risk factors could significantly contribute towards reduction of CVD in the HIV population. This study underscores the importance of new screening strategies to be effectively incorporated in ART program. However, many opportunities exist for developing interventions for optimal screening, treatment and prevention of CVD in patients on ART.

Published in	Cardiology and Cardiovascular Research (Volume 1, Issue 4)
DOI	10.11648/j.ccr.20170104.11
Page(s)	98-103
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2017. Published by Science Publishing Group

Keywords

CVD, HIV Seropositive, Protease Inhibitors, ART

References

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[7]	Pearce D, Ani C, Espinosa-Silva Y, et al. Comparison of in-hospital mortality from acute myocardial infarction in HIV sero-positive versus sero-negative individuals. The American journal of cardiology; 2012; 110(8): 1078-84.
[8]	Constans J, P. J., Peuchant E. Plasma lipids in HIV-infected patients: a prospective study in 95 patients. Eur J Clin Invest 1994; 24: p. 416-206.
[9]	Leite, R. (2010). Metabolic profile and cardiovascular risk factors among Latin American HIV infected patients receiving HAART Cahn. Braz J Infect Dis 2010; 14 (2): 158-166.
[10]	Fitch KV, Looby SE, Rope A, et al., (2013). Effects of aging and smoking on carotid intima-media thickness in HIV-infection. AIDS (London, England); 27(1): 49-57.
[11]	Riddler SA, Li X, Chu H, et al. Longitudinal changes in serum lipids among HIV-infected men on highly active antiretroviral therapy. HIV Med. 2007; 8: 280–287.
[12]	Walmsley S, Bernstein B, King M, et al. Lopinavir-ritonavir versus nelfinavir for the initial treatment of HIV infection. N Engl J Med. 2002; 346: 2039–2046.
[13]	Carr A, Samaras K, Thorisdottir A, Kaufmann GR, Chisholm DJ, Cooper DA. Diagnosis, prediction, and natural course of HIV-1 protease-inhibitor-associated lipodystrophy, hyperlipidemia, and diabetes mellitus: a cohort study. Lancet. 1999; 353: 2093–2099.
[14]	Friis-Møller N, Weber R, Reiss P, et al. Cardiovascular disease risk factors in HIV patients – association with antiretroviral therapy, results from the DAD study. AIDS. 2003; 17: 1179–1193.
[15]	Valdez H, Connick E, Smith KY, et al. Limited immune restoration after 3 years suppression of HIV-1 replication in patients with moderately advanced disease. AIDS. 2002; 16: 1859–1866.
[16]	Diouf, A., et al., Diabetes and hypertension among patients receiving antiretroviral treatment since 1998 in Senegal: prevalence and associated factors. ISRN AIDS, 2012.

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Brian Chiluba, Esther Munalula-Nkandu, Chola Nakazwe Daka, Mumbi Chola, Gershom Chongwe. (2017). Cardiovascular Disease Risk from Protease Inhibitors-ART for HIV: Retrospective Cohort of University Teaching Hospital, Zambia. Cardiology and Cardiovascular Research, 1(4), 98-103. https://doi.org/10.11648/j.ccr.20170104.11

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ACS Style

Brian Chiluba; Esther Munalula-Nkandu; Chola Nakazwe Daka; Mumbi Chola; Gershom Chongwe. Cardiovascular Disease Risk from Protease Inhibitors-ART for HIV: Retrospective Cohort of University Teaching Hospital, Zambia. Cardiol. Cardiovasc. Res. 2017, 1(4), 98-103. doi: 10.11648/j.ccr.20170104.11

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AMA Style

Brian Chiluba, Esther Munalula-Nkandu, Chola Nakazwe Daka, Mumbi Chola, Gershom Chongwe. Cardiovascular Disease Risk from Protease Inhibitors-ART for HIV: Retrospective Cohort of University Teaching Hospital, Zambia. Cardiol Cardiovasc Res. 2017;1(4):98-103. doi: 10.11648/j.ccr.20170104.11

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@article{10.11648/j.ccr.20170104.11,
  author = {Brian Chiluba and Esther Munalula-Nkandu and Chola Nakazwe Daka and Mumbi Chola and Gershom Chongwe},
  title = {Cardiovascular Disease Risk from Protease Inhibitors-ART for HIV: Retrospective Cohort of University Teaching Hospital, Zambia},
  journal = {Cardiology and Cardiovascular Research},
  volume = {1},
  number = {4},
  pages = {98-103},
  doi = {10.11648/j.ccr.20170104.11},
  url = {https://doi.org/10.11648/j.ccr.20170104.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ccr.20170104.11},
  abstract = {The burden of Cardiovascular Disease (CVD) in Sub-Saharan Africa is rising amidst a high prevalence of infectious diseases including HIV. While use of certain Antiretroviral Therapy (ART) drugs has been shown to cause dyslipidaemia, little is known about the burden of CVD in the presence of Protease Inhibitors (PIs) in Sub-Saharan Africa. We investigated the incidence and risks associated with the use of PI-containing ART in the development of CVD among HIV seropositive adults at the University Teaching Hospital, Zambia. For this purpose a retrospective cohort study was used to review records of patients on PIs and non PIs between January 2008 and January 2016. The end point of the study was CVD (n=281). Generalized linear models using a log-binomial link were used to assess covariates, while Kaplan Meier method for probability of survival to CVD and time to CVD comorbidity were utilised. The results showed that the incidence of CVD among PIs was 62%, while among the non-PI ART group it was 38%. The risk of CVD was 2.3 times higher (p<0.001; 95% CI: 1.86-2.81) in the PIs ART group than non-PI ART group. Risk factors included; Age, CD4 cell count, Type of ART, Years since HIV diagnosis and BMI, with the CVD attributable risk of 56%. The Kaplan-Meier survival estimates for CVD showed a marked difference in survivorship between the two ART groups (Log-rank P=0.003). Based on this therefore, prolonged use of PI-containing ART was significantly associated with a higher incidence of CVD. Addressing the modifiable risk factors could significantly contribute towards reduction of CVD in the HIV population. This study underscores the importance of new screening strategies to be effectively incorporated in ART program. However, many opportunities exist for developing interventions for optimal screening, treatment and prevention of CVD in patients on ART.},
 year = {2017}
}

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TY - JOUR
T1 - Cardiovascular Disease Risk from Protease Inhibitors-ART for HIV: Retrospective Cohort of University Teaching Hospital, Zambia
AU - Brian Chiluba
AU - Esther Munalula-Nkandu
AU - Chola Nakazwe Daka
AU - Mumbi Chola
AU - Gershom Chongwe
Y1 - 2017/08/30
PY - 2017
N1 - https://doi.org/10.11648/j.ccr.20170104.11
DO - 10.11648/j.ccr.20170104.11
T2 - Cardiology and Cardiovascular Research
JF - Cardiology and Cardiovascular Research
JO - Cardiology and Cardiovascular Research
SP - 98
EP - 103
PB - Science Publishing Group
SN - 2578-8914
UR - https://doi.org/10.11648/j.ccr.20170104.11
AB - The burden of Cardiovascular Disease (CVD) in Sub-Saharan Africa is rising amidst a high prevalence of infectious diseases including HIV. While use of certain Antiretroviral Therapy (ART) drugs has been shown to cause dyslipidaemia, little is known about the burden of CVD in the presence of Protease Inhibitors (PIs) in Sub-Saharan Africa. We investigated the incidence and risks associated with the use of PI-containing ART in the development of CVD among HIV seropositive adults at the University Teaching Hospital, Zambia. For this purpose a retrospective cohort study was used to review records of patients on PIs and non PIs between January 2008 and January 2016. The end point of the study was CVD (n=281). Generalized linear models using a log-binomial link were used to assess covariates, while Kaplan Meier method for probability of survival to CVD and time to CVD comorbidity were utilised. The results showed that the incidence of CVD among PIs was 62%, while among the non-PI ART group it was 38%. The risk of CVD was 2.3 times higher (p<0.001; 95% CI: 1.86-2.81) in the PIs ART group than non-PI ART group. Risk factors included; Age, CD4 cell count, Type of ART, Years since HIV diagnosis and BMI, with the CVD attributable risk of 56%. The Kaplan-Meier survival estimates for CVD showed a marked difference in survivorship between the two ART groups (Log-rank P=0.003). Based on this therefore, prolonged use of PI-containing ART was significantly associated with a higher incidence of CVD. Addressing the modifiable risk factors could significantly contribute towards reduction of CVD in the HIV population. This study underscores the importance of new screening strategies to be effectively incorporated in ART program. However, many opportunities exist for developing interventions for optimal screening, treatment and prevention of CVD in patients on ART.
VL - 1
IS - 4
ER -

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Author Information

Brian Chiluba

National Health Research Authority, Ministry of Health, Lusaka, Zambia
Esther Munalula-Nkandu

Department of Physiotherapy, School of Health Sciences, The University of Zambia, Lusaka, Zambia
Chola Nakazwe Daka

Central Statistical Office, Lusaka, Zambia
Mumbi Chola

National Health Research Authority, Ministry of Health, Lusaka, Zambia
Gershom Chongwe

National Health Research Authority, Ministry of Health, Lusaka, Zambia

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APA Style

Brian Chiluba, Esther Munalula-Nkandu, Chola Nakazwe Daka, Mumbi Chola, Gershom Chongwe. (2017). Cardiovascular Disease Risk from Protease Inhibitors-ART for HIV: Retrospective Cohort of University Teaching Hospital, Zambia. Cardiology and Cardiovascular Research, 1(4), 98-103. https://doi.org/10.11648/j.ccr.20170104.11

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ACS Style

Brian Chiluba; Esther Munalula-Nkandu; Chola Nakazwe Daka; Mumbi Chola; Gershom Chongwe. Cardiovascular Disease Risk from Protease Inhibitors-ART for HIV: Retrospective Cohort of University Teaching Hospital, Zambia. Cardiol. Cardiovasc. Res. 2017, 1(4), 98-103. doi: 10.11648/j.ccr.20170104.11

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AMA Style

Brian Chiluba, Esther Munalula-Nkandu, Chola Nakazwe Daka, Mumbi Chola, Gershom Chongwe. Cardiovascular Disease Risk from Protease Inhibitors-ART for HIV: Retrospective Cohort of University Teaching Hospital, Zambia. Cardiol Cardiovasc Res. 2017;1(4):98-103. doi: 10.11648/j.ccr.20170104.11

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@article{10.11648/j.ccr.20170104.11,
  author = {Brian Chiluba and Esther Munalula-Nkandu and Chola Nakazwe Daka and Mumbi Chola and Gershom Chongwe},
  title = {Cardiovascular Disease Risk from Protease Inhibitors-ART for HIV: Retrospective Cohort of University Teaching Hospital, Zambia},
  journal = {Cardiology and Cardiovascular Research},
  volume = {1},
  number = {4},
  pages = {98-103},
  doi = {10.11648/j.ccr.20170104.11},
  url = {https://doi.org/10.11648/j.ccr.20170104.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ccr.20170104.11},
  abstract = {The burden of Cardiovascular Disease (CVD) in Sub-Saharan Africa is rising amidst a high prevalence of infectious diseases including HIV. While use of certain Antiretroviral Therapy (ART) drugs has been shown to cause dyslipidaemia, little is known about the burden of CVD in the presence of Protease Inhibitors (PIs) in Sub-Saharan Africa. We investigated the incidence and risks associated with the use of PI-containing ART in the development of CVD among HIV seropositive adults at the University Teaching Hospital, Zambia. For this purpose a retrospective cohort study was used to review records of patients on PIs and non PIs between January 2008 and January 2016. The end point of the study was CVD (n=281). Generalized linear models using a log-binomial link were used to assess covariates, while Kaplan Meier method for probability of survival to CVD and time to CVD comorbidity were utilised. The results showed that the incidence of CVD among PIs was 62%, while among the non-PI ART group it was 38%. The risk of CVD was 2.3 times higher (p<0.001; 95% CI: 1.86-2.81) in the PIs ART group than non-PI ART group. Risk factors included; Age, CD4 cell count, Type of ART, Years since HIV diagnosis and BMI, with the CVD attributable risk of 56%. The Kaplan-Meier survival estimates for CVD showed a marked difference in survivorship between the two ART groups (Log-rank P=0.003). Based on this therefore, prolonged use of PI-containing ART was significantly associated with a higher incidence of CVD. Addressing the modifiable risk factors could significantly contribute towards reduction of CVD in the HIV population. This study underscores the importance of new screening strategies to be effectively incorporated in ART program. However, many opportunities exist for developing interventions for optimal screening, treatment and prevention of CVD in patients on ART.},
 year = {2017}
}

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