Cardiovascular Comorbidities, Hypertension and Associated Factors in Adults Living with HIV in Jos, Nigeria

Abstract

Background: Persons living with HIV infection (PLHIV) are reported to be predisposed to cardiovascular diseases (CVD’s) through multiple mechanisms. Recent reports are indicating the emergence of  a CVD epidemic within the HIV/AIDS pandemic with consequent added socio-economic burden particularly in low-resource environment. This study sought to evaluate the prevalence of cardiovascular co-morbidities, hypertension  and risk assessment in a cohort of PLHIV in Nigeria. Methods: This was a longitudinal study. Adult clients of the HIV clinic of Jos University Teaching Hospital who met the study criteria were enrolled in a simple random manner. Three hundred PLHIV and one hundred (age and sex matched) HIV negative (HIV-) persons were enrolled. Relevant history, physical examination and investigations were obtained and each participant followed up for 12 months for outcomes of interest. Data was analyzed using STATA version 14, P value < 0.05 was considered significant; the prevalence (with confidence intervals) of cardiovascular comorbidities, hypertension and associated factors were determined for each participant. The baseline cross-sectional results are reported in this paper. Results: There were 177 females and 123 males PLHIV with 59 females and 41 males HIV- participants. The mean ages were 41.26±13.2 and 40.5±12.9 years respectively (P=0.98). The prevalence of hypertension was 26.0% (21.1-31.4%) in HIV+ and 8.0% (3.5-15.2%) in HIV- participants, P=0.001. HIV+ participants had statistically significant elevated Framingham risk score (FRS) compared to the HIV- participants, P=0.002.  56% of the HIV+ participants had abnormal echocardiography, 59% had abnormal electrocardiogram and 40.7% (35.1-46.5%) a clinical diagnosis of cardiovascular comorbidity. Pericardial disease was the commonest echocardiography finding while atrial ectopics was the commonest electrocardiography finding.  Hypertensive heart disease (24%, 19.2-28.8%) was the commonest cardiovascular comorbidity. Conclusion: PLHIV are at higher risk for developing hypertension and other cardiovascular co-morbidities.  Integration of routine screening and management for CVD risk factors and cardio-metabolic co-morbidities are recommended for PLHIV. This will significantly reduce morbidity, improve quality of life and prolong life in these patients.