Cardio-metabolic effects of anti-retroviral treatment in the Cape Winelands region of South Africa

Abaid, Faten E. Bashir (2016-03)

Thesis (MSc)--Stellenbosch University, 2016.

Thesis

ENGLISH ABSTRACT: Background: Although highly active antiretroviral therapy (HAART) has significantly improved the survival of human immunodeficiency virus (HIV)-infected patients there are increased concerns regarding the onset of co-morbidities (e.g. cardio-metabolic complications) and mortalities. Although South Africa is burdened with the highest number of HIV-infected individuals globally, there is a relative paucity of data regarding potential links between HIV infection, HAART and cardio-metabolic risk/onset. Methods: This cross-sectional study therefore investigated the prevalence of cardio-metabolic risk factors in HIV-infected individuals within the Cape Winelands region of South Africa. Here we collected anthropometric, biochemical and lifestyle-related data for HIV-positive HAART naive (n =25) and HIV-positive individuals on HAART (n = 50) patients (20–55 years old) at the Worcester Community Day Centre (CDC) (Worcester, Western Cape, South Africa) during 2014 and 2015. Subjects on HAART were further divided into two sub-groupings, i.e. first line (n = 25) and second line treatments (n = 25). Results: Our data reveal the relatively high prevalence of traditional, cardio-metabolic lifestyle risk factors in HIV-infected individuals. There was a relatively high prevalence of smoking, i.e. 88% for the HIV-positive HAART naive group and 27% for the HIV-positive group on HAART (P = 0.001), while more than half of the HIV-positive individuals exhibited a positive history of familial cardiovascular diseases (CVD). There were no significant differences for fasting blood glucose (FBG) and insulin levels between HIV-positive HAART naive and HIV-positive on HAART. Lipid metabolite analyses (Total cholesterol [TC], low-density lipoprotein [LDL], high density lipoprotein [HDL] and triglyceride [TG]) also did not reveal significant changes when comparing HIV-positive on HAART versus HIV-positive HAART naive groups. However, additional analyses (using established cut-off values for HDL, LDL) showed a significant difference in the proportion of individuals categorized with ‘’low HDL’’ status, i.e. 68% for the HIV-positive HAART naive compared to 40% for the HIV-positive on HAART group (P =0.022). HAART also enhanced anthropometric measures of obesity, with significant differences for weight gain, triceps skin fold (TSF), biceps skin fold (BSF), waist circumference (WC) and mid-upper arm circumference (MUAC) between the naive and HAART groups. This applied similarly for first and second line treatments. Conclusion: The study established the prevalence of several traditional lifestyle CVD risk factors in both HIV-positive naive and HIV-positive on HAART in the Cape Winelands region of South Africa. HAART enhanced several measure of weight gain and lipid profile, suggesting a restoration to health and well-being. However, there was a relatively high prevalence of obesity in the HIV-positive on HAART group (especially females) thus placing them at a greater risk for the onset of future cardio-metabolic complications. We are unable to distinguish whether this risk is due to HAART or lifestyle-related risk factors, and this question requires further investigation. The findings of this study indicate that clinicians should be attentive of lifestyle-related CVD risk factors in HIV-positive persons and make an effort to counsel patients to adopt improved lifestyle choices.

AFRIKAANSE OPSOMMING: Agtergrond: Alhoewel hoogs-aktiewe antriretrovirale terapie (HAART) die oorlewing van menslike immuniteitsgebrek virus (MIV)-geïnfekteerde pasiënte beduidend verbeter, is daar toenemende kommer aangaande die ontwikkeling van ko-morbiditeite (o.a. kardio-metaboliese komplikasies) en mortaliteit. Alhoewel Suid-Afrika gebuk gaan onder die grootste aantal MIV-geïnfekteerde individue wêreldwyd, is daar ‘n relatiewe tekort aan data wat die potensiële verband tussen MIV infeksie, HAART en kardio-metaboliese risiko/aanvang betref. Metodes: Hierdie dwarssnitstudie ondersoek dus die voorkoms van kardio-metaboliese risiko faktore in MIV-geïnfekteerde individue binne die Kaapse Wynland distrik van Suid-Afrika. Hier het ons antropometriese, biochemiese en lewensstyl-verwante data vir MIV-positiewe HAART naïewe (n = 25) en MIV-positiewe individue op HAART (n=50; 20-55 jaar oud) by die Worcester Gemeenskaps-dagsentrum (Worcester, Weskaap, Suid-Afrika) gedurende 2014 en 2015 versamel. Pasiënte op HAART is verder verdeel in twee sub-groepe, nl. eerste linie (n = 25) en tweede linie (n = 25) behandeling. Resultate: Ons data het ‘n relatiewe hoë voorkoms van tradisionele, kardio-metaboliese lewensstyl risiko faktore onder MIV-geïnfekteerde individue onthul. Daar was ‘n relatiewe hoë voorkoms van rook, nl. 88% vir die MIV-positiewe HAART-naïewe groep en 27% vir die MIV-positiewe groep op HAART (P = 0.001), terwyl meer as helfte van die MIV-positiewe individue ‘n positiewe geskiedenis van oorerflike kardiovaskulêre siektes (KVS) getoon het. Daar was geen beduidende verskille in vastende bloedglukose (FBG) en insulienvlakke tussen MIV-positiewe HAART naïewe en MIV-positiewe pasiënte op HAART behandeling nie. Lipied metaboliet analise (Totale cholesterol [TC], lae-digtheid lipoprotein [LDL], hoë-digtheid lipoprotein [HDL] en trigliseriede [TG]) het ook geen beduidende veranderinge onthul toe MIV-positiewe op HAART vs. MIV-positiewe HAART naïewe groepe vergelyk is nie. Additionele analise (deur gebruik te maak van afsny-waardes vir HDL, LDL) het egter beduidende verskille aangetoon in die proporsie individue gekategoriseer met “lae HDL” status, nl. 68% vir MIV-positiewe HAART naïewe pasiënte, in vergelyking met 40% vir MIV-positiewe pasiënte op HAART (P = 0.022). HAART het ook die antropometriese mate van vetsugtigheid verbeter, met beduidende verskille in massa-toename, triseps velvou (TSF), biseps velvou (BSF), middelmaat (WC) en mid-boarm omtrek (MUAC) tussen die naïewe en HAART groepe. Hierdie was soortgelyk vir eerste en tweede linie behandeling met HAART. Afleiding: Hierdie studie het die teenwoordigheid van verskeie tradisionele lewensstyl KVS risiko faktore in beide MIV-positiewe HAART-naïewe en MIV-positiewe op HAART bevestig in die Kaap Wynland distrik van Suid-Afrika. HAART het verskeie mates van massa toename en die lipied profiel verbeter, wat moontlike herstel van gesondheid en welwees aangedui het. Daar was egter ‘n relatief hoë voorkoms van vetsug in die MIV-postiewe op HAART groep (veral vroulike pasiënte) wat hulle dus onder ‘n verhoogde risiko vir die ontwikkeling van toekomstige kardio-metaboliese komplikasies plaas.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/98734
This item appears in the following collections: