Cardiometabolic risk factors associated with subclinical atherosclerosis in patients living with HIV versus non-HIV patients

Abstract

Introduction : The aim of this work was to identify traditional and emerging cardiometabolic risk factors associated with subclinical atherosclerosis in Patients living with HIV and non-HIV patients ;
Methods: This was a descriptive and analytical cross-sectional study between January 2017 and December 2021 in People Living with HIV (PLHIV) and non-HIV cared for in the structures of the Réseau Catholique du Bureau Diocésain des Oeuvres Médicales (BDOM) and at the Cliniques Universitaires de Kinshasa (CUK). Subclinical atherosclerosis was defined by : pulse pressure (PP) ≥60 mm Hg; carotid intima-media thickness (cIMT) >0.8 mm and systolic pressure index (SPI) <0.9. Multivariate discriminant analysis was used to classify patients into different groups based on their characteristics. A value of P < 0.05 was considered statistically significant.
Results: A total of 405 patients were recruited, including 334 PLHIV (321 on ART and 13 ART-naive) and 71 HIV-uninfected patients. The mean age of the study population was 54±14 years, with a female predominance of 70.1% (n=284); there was a significant bivariate correlation between sex (p=0.028), marital status (p=0.010) and religion (p=0.010) with advancing age in PLHIV.Among non-HIV, gender (p=0.032), occupation (p=0.0005) and level of education (p<0.0001) were significantly associated with
advancing age.In multivariate discriminant analysis: In men, only SPI, and LDL/HDL
were able to discriminate between HIV-, HIV+ ART-naive, HIV+/LPV/r, HIV+/EFV,
HIV+/NVP, HIV+/DTG groups. In women, only creatinine, cIAE, TG/HDL, LDL/HDL
and TC/HDL were able to discriminate between HIV-, ART-naive HIV+, HIV+/LPV/r,
HIV+/EFV, HIV+/NVP, HIV+/DTG groups.
Conclusion : Compared with non-HIV-infected patients, mean values for emerging and traditional cardiometabolic risk factors are elevated in ART-naive and ART-treated
PLHIV. All ARVs are identified as predictors of subclinical atherosclerosis, but
Lopinavir/ritonavir much more so, while dolutegravir is identified as the less
atherogenic molecule than the other antiretrovirals.