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

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  • معلومة اضافية
    • Subject Terms:
    • Author-Supplied Keywords:
      cardiovascular
      diabetes
      hypertension
      South Africa
    • Abstract:
      Introduction: People with HIV (PWH) are at increased risk for atherosclerotic cardiovascular disease (CVD). Screening for CVD risk factors is recommended but not routine in South African HIV clinics. We sought to describe the prevalence of CVD risk factors among antiretroviral treatment (ART)‐experienced patients in South Africa. Methods: We performed a prospective, observational cross‐sectional study of PWH (>21 years, excluding pregnant women) on ART in South Africa. We interviewed patients regarding CVD risk factors, and obtained two blood pressure (BP) measurements and random/fasting glucose via a point‐of‐care glucometer. Standardized chart reviews provided individuals' HIV‐specific data. We defined hypertension as: self‐reported use of antihypertensives or mean systolic BP (SBP) ≥140 mmHg or diastolic BP (DBP) ≥90 mmHg (Stage 1) or SBP ≥160 mmHg or DBP ≥100 mmHg (Stage 2). We defined diabetes as self‐reported use of insulin/oral hypoglycaemics or fasting (random) glucose ≥7.0 (≥11.1) mmol. We obtained risk ratios (RR) for hypertension from a multivariable log‐binomial regression model, adjusting for age, sex and diabetes. Results: From March 2015 to February 2016, 458 participants enrolled with median age 38 years (interquartile range (IQR) 33 to 44 years) and median CD4 466/μL (IQR 317 to 638/μL); 78% were women. Participants were on ART for a median of four years, with 33% on ART ≥6 years. Almost a quarter (106/458) met the study definition for hypertension, of whom 45/106 (42%) were previously diagnosed, 23/45 (51%) were on medication and 4/23 (17%) were controlled. Eight participants had asymptomatic hypertensive urgency (BP≥180/110 mmHg). Of the 458 participants, 26 (6%) met the study definition for diabetes, half of whom (13/26) were already diagnosed; 11/13 (85%) were on treatment, of whom 4/11 (36%) had normal glucose. Age was the only significant predictor of hypertension (RR, 1.04; 95% CI, 1.03 to 1.06, p < 0.0001) in the multivariable model. Conclusions: Hypertension and diabetes were prevalent among PWH prescribed ART in South Africa with less than half diagnosed, and still fewer treated and controlled. Hypertension was independently associated with age but not with HIV‐specific factors. Screening for and treatment of CVD risk factors could decrease future morbidity and mortality, especially as this population ages. [ABSTRACT FROM AUTHOR]
    • Abstract:
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    • Author Affiliations:
      1Medical Practice Evaluation Center, Massachusetts General Hospital, Boston MA, USA
      2Division of Infectious Diseases, Massachusetts General Hospital, Boston MA, USA
      3Harvard University Center for AIDS Research (CFAR), Boston MA, USA
      4Harvard Medical School, Boston MA, USA
      5Desmond Tutu HIV Centre, Institute of Infectious Disease & Molecular Medicine and Department of Medicine Faculty of Health Sciences, University of Cape Town, Cape Town South Africa
      6Biostatistics Center, Massachusetts General Hospital, Boston MA, USA
      7Division of Infectious Diseases, Brigham and Women's Hospital, Boston MA, USA
      8Division of General Internal Medicine, Massachusetts General Hospital, Boston MA, USA
    • ISSN:
      1758-2652
    • Accession Number:
      10.1002/jia2.25274
    • Accession Number:
      136173506
  • Citations
    • ABNT:
      HYLE, E. P. et al. Cardiovascular risk factors among ART‐experienced people with HIV in South Africa. Journal of the International AIDS Society, [s. l.], v. 22, n. 4, p. N.PAG, 2019. Disponível em: . Acesso em: 15 set. 2019.
    • AMA:
      Hyle EP, Bekker L, Martey EB, et al. Cardiovascular risk factors among ART‐experienced people with HIV in South Africa. Journal of the International AIDS Society. 2019;22(4):N.PAG. doi:10.1002/jia2.25274.
    • APA:
      Hyle, E. P., Bekker, L., Martey, E. B., Huang, M., Xu, A., Parker, R. A., … Middelkoop, K. (2019). Cardiovascular risk factors among ART‐experienced people with HIV in South Africa. Journal of the International AIDS Society, 22(4), N.PAG. https://doi.org/10.1002/jia2.25274
    • Chicago/Turabian: Author-Date:
      Hyle, Emily P, Linda‐Gail Bekker, Emily B Martey, Mingshu Huang, Ai Xu, Robert A Parker, Rochelle P Walensky, and Keren Middelkoop. 2019. “Cardiovascular Risk Factors among ART‐experienced People with HIV in South Africa.” Journal of the International AIDS Society 22 (4): N.PAG. doi:10.1002/jia2.25274.
    • Harvard:
      Hyle, E. P. et al. (2019) ‘Cardiovascular risk factors among ART‐experienced people with HIV in South Africa’, Journal of the International AIDS Society, 22(4), p. N.PAG. doi: 10.1002/jia2.25274.
    • Harvard: Australian:
      Hyle, EP, Bekker, L, Martey, EB, Huang, M, Xu, A, Parker, RA, Walensky, RP & Middelkoop, K 2019, ‘Cardiovascular risk factors among ART‐experienced people with HIV in South Africa’, Journal of the International AIDS Society, vol. 22, no. 4, p. N.PAG, viewed 15 September 2019, .
    • MLA:
      Hyle, Emily P., et al. “Cardiovascular Risk Factors among ART‐experienced People with HIV in South Africa.” Journal of the International AIDS Society, vol. 22, no. 4, Apr. 2019, p. N.PAG. EBSCOhost, doi:10.1002/jia2.25274.
    • Chicago/Turabian: Humanities:
      Hyle, Emily P, Linda‐Gail Bekker, Emily B Martey, Mingshu Huang, Ai Xu, Robert A Parker, Rochelle P Walensky, and Keren Middelkoop. “Cardiovascular Risk Factors among ART‐experienced People with HIV in South Africa.” Journal of the International AIDS Society 22, no. 4 (April 2019): N.PAG. doi:10.1002/jia2.25274.
    • Vancouver/ICMJE:
      Hyle EP, Bekker L, Martey EB, Huang M, Xu A, Parker RA, et al. Cardiovascular risk factors among ART‐experienced people with HIV in South Africa. Journal of the International AIDS Society [Internet]. 2019 Apr [cited 2019 Sep 15];22(4):N.PAG. Available from: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=asn&AN=136173506&custid=s8280428