Association between cardio-ankle vascular index and cardiometabolic risk factors in HIV patients in Ghana

ABSTRACT

Human immunodeficiency virus (HIV) infection is associated with increased cardiovascular diseases (CVDs) even in patients with viral suppression by combination antiretroviral therapy (cART). Arterial stiffness is an independent predictor of CVDs in diseased individuals and the general population. Cardio-ankle vascular index (CAVI) is an index of arterial stiffness that has been shown to predict target organ damage. CAVI is less studied in HIV patients. We compared the levels of arterial stiffness using CAVI and associated factors among cART-treated and cART-naïve HIV patients to those of non-HIV controls. In a case-control design, 158 cART-treated HIV patients, 150 cART-naïve HIV patients and 156 non-HIV controls were recruited from a periurban hospital. We collected data on CVD risk factors, anthropometric characteristics, CAVI, and fasting blood samples to measure plasma glucose, lipid profile, and CD4+ cell counts. Metabolic abnormalities were defined using the JIS criteria. CAVI increased in cART-treated HIV patients compared to cART-naïve HIV patients and non-HIV controls (7.8 ± 1.4 vs 6.6 ± 1.1 vs 6.7 ± 1.4 respectively, p < 0.001). CAVI was associated with metabolic syndrome in non-HIV controls [OR (95% CI) = 2.14 (1.04–4.4), p = 0.039] and cART-naïve HIV patients [1.47 (1.21–2.38), p = 0.015], but not in cART-treated HIV patients [0.81 (0.52–1.26), p = 0.353]. In cART-treated HIV patients, a tenofovir (TDF)-based regimen (β = −0.46, p = 0.023) was associated with decreased CAVI and decreased CD4+ cell count (β = −0.23, p = 0.047) was associated with increased CAVI. In a periurban hospital in Ghana, compared to non-HIV controls or cART-naïve HIV patients, cART-treated HIV patients had increased arterial stiffness measured as CAVI. CAVI is associated with metabolic abnormalities in non-HIV controls and cART-naïve HIV patients, but not in cART-treated HIV patients. Patients on TDF-based regimens had decreased CAVI.

KEYWORDS:

• Arterial stiffness
• CAVI
• HIV
• cardiometabolic risk factors
• cART

Abbreviations

BMI	=	body mass index
BP	=	blood pressure
Cart	=	combination antiretroviral therapy
CAVI	=	cardio-ankle vascular index
CVD	=	cardiovascular diseases
FPG	=	fasting blood glucose
HDL	=	high-density lipoprotein
HIV	=	human immunodeficiency virus
LDL	=	low-density lipoprotein
MetS	=	metabolic syndrome
PWV	=	pulse wave velocity

Acknowledgments

We thank all the participants in the HIV clinics at Atua Government Hospital who voluntarily participated in this study. We thank community health volunteers and healthcare providers at HIV clinics for their overwhelming support during the study. Our heartfelt thanks go to Mrs Nneka Essel for her assistance.

Disclosure statement

No potential conflict of interest was reported by the authors.

Authors’ contributions

KY conceptualized the study, analysed the data and drafted the manuscript. SE collected the data and revised the manuscript. JAA analyzed the data and made scientific contributions to the manuscript. BD reviewed the manuscript and made scientific contributions to the manuscript. All authors approved the content of the manuscript.

Availability of data

A data set supporting the conclusions of this paper is available and can be requested from the corresponding author.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/19932820.2023.2215636.

Additional information

Funding

There was no funding for this study.