Risk of Cardiovascular Disease Inhibitors Among HIV seropositive Adults on Protease Inhibitors Containing Antiretroviral Therapy at Adult Infectious Disease Centre at the University Teaching Hospital

Abstract

Introduction: The burden of cardiovascular disease (CVD) in Sub-Saharan Africa is rising in the background of a high prevalence of infectious diseases including Human Immune Deficiency Virus (HIV). The use of certain Antiretroviral Therapy (ART) drugs has been shown to cause dyslipidaemia, with little known about the burden of dyslipidaemia in the presence of ART particularly Protease Inhibitors (PIs) in Sub-Saharan Africa. The objective of this study was to determine the risk associated with the use of PIs- containing ART in the development of CVD among HIV seropositive adult’s at the Adult Infectious Disease Centre University Teaching Hospital (UTH), Zambia. Methods: This was a retrospective cohort study that reviewed records of patients on PIs and non- PIs between 2008 and 2016. The primary end point of the study was CVD and consisted of a total sample of 281, with PI consisting of 112 and 169 for the non PI group. A log-binomial model was used to assess covariates, while Kaplan Meier method for probability of survival to CVD and time to CVD comorbidity were utilised. Results: The incidence of CVD among PIs was 62% versus 38% for the non-PI ART group. The risk of CVD was found to be 2.3 times higher in the PIs ART group than non-PI ART group. Associated factors include; age, CD4 cell count, type of ART, years since HIV diagnosis and BMI. Kaplan-Meier survival estimates for CVD showed a statistical difference (log-rank; p=0.003) in the two groups (PI and non-PI), were survival was more in the non-PI group, hence a higher cumulative incidence of CVD was observed in the PI group. Conclusion: Prolonged use of PIs especially older generation drugs containing ART for at least a period of over 2 years were significantly associated with a higher incidence of cardiovascular disease. This study underscores the importance of new screening strategies to be effectively incorporated in ART program among Human immune deficiency virus seropositive adults. Cardiovascular disease has emerged as an important cause of morbidity among seropositive adults. Human immune deficiency virus, antiretroviral therapy and host factors contribute to cardiovascular disease. However, many opportunities exist for developing interventions for optimal screening, treatment and prevention of cardiovascular in Zambia.