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Short-term and long-term cardiovascular risk, metabolic syndrome and HIV in Tanzania
  1. Justin R Kingery1,2,3,4,
  2. Yona Alfred1,2,
  3. Luke R Smart1,2,4,
  4. Emily Nash4,
  5. Jim Todd5,
  6. Mostafa R Naguib6,
  7. Jennifer A Downs1,2,4,
  8. Samuel Kalluvya1,2,
  9. Johannes B Kataraihya1,2,
  10. Robert N Peck1,2,3,4
  1. 1Department of Internal Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
  2. 2Department of Internal Medicine, Bugando Medical Centre, Mwanza, Tanzania
  3. 3Division of Hospital Medicine, Department of Internal Medicine, Weill Cornell Medical College, New York City, New York, USA
  4. 4Department of Internal Medicine, Center for Global Health, Weill Cornell Medical College, New York City, New York, USA
  5. 5Population Health Department, London School of Hygiene & Tropical Medicine, London, UK
  6. 6Department of Medicine, Weill Cornell Medical College-Qatar, Doha, Qatar
  1. Correspondence to Dr Justin R Kingery, Department of Internal Medicine, Catholic University of Health and Allied Sciences, PO Box 5034, 33100, Mwanza, Tanzania; jrk9006{at}med.cornell.edu

Abstract

Objective To compare short-term and long-term cardiovascular disease (CVD) risk scores and prevalence of metabolic syndrome in HIV-infected adults receiving and not receiving antiretroviral therapy (ART) to HIV-negative controls.

Methods A cross-sectional study including 151 HIV-infected, ART-naive, 150 HIV-infected on ART and 153 HIV-negative adults. Traditional cardiovascular risk factors were determined by standard investigations. The primary outcome was American College of Cardiology/American Heart Association Atherosclerotic CVD (ASCVD) Risk Estimator lifetime CVD risk score. Secondary outcomes were ASCVD 10-year risk, Framingham risk scores, statin indication and metabolic syndrome.

Results Compared with HIV-negative controls, more HIV-infected adults on ART were classified as high lifetime CVD risk (34.7% vs 17.0%, p<0.001) although 10-year risk scores were similar, a trend which was similar across multiple CVD risk models. In addition, HIV-infected adults on ART had a higher prevalence of metabolic syndrome versus HIV-negative controls (21.3% vs 7.8%, p=0.008), with two common clusters of risk factors. More than one-quarter (28.7%) of HIV-infected Tanzanian adults on ART meet criteria for statin initiation.

Conclusions HIV-infected ART-treated individuals have high lifetime cardiovascular risk, and this risk seems to develop rapidly in the first 3–4 years of ART as does the development of clusters of metabolic syndrome criteria. These data identify a new subgroup of low short-term/high–lifetime risk HIV-infected individuals on ART who do not currently meet criteria for CVD risk factor modification but require further study.

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