Browsing by Author "Kgokane, Boipelo Mirriam Lepetjia"

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    Cardio-metabolic risk profile of people living with HIV: Is retinal microvascular geometric morphology a marker of effect?
    (Stellenbosch : Stellenbosch University, 2022-04) Kgokane, Boipelo Mirriam Lepetjia; Strijdom, Hans; Everson, Frans; Kamau, Festus; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Biomedical Sciences: Medical Physiology.
    Background and Aim Cardiovascular disease in people living with HIV has become of great concern. HI-viral factors, ART-toxicity and HIV/ART-associated cardiometabolic adverse effects have been implicated in the development of cardiovascular disease. Retinal microvascular geometric features may be potential useful markers of these effects. We aimed to investigate whether altered retinal microvascular geometric features are markers of HIV, ART and/or HIV/ART-associated cardiometabolic effects in a study population from the Western Cape Province. Methods The study followed a cross-sectional (HIV-free: n = 88 and HIV+ART: n = 122) and longitudinal (baseline vs. 18-month follow-up for HIV+ART only: n = 82) study design. Volunteering participants were recruited from health care clinics. Demographic, lifestyle, socioeconomic and anthropometric data were collected. Fasting blood and urine samples were collected and transported to the National Health Laboratory Services for biochemical analyses. Retinal images were obtained (Canon CR-2 camera) and vessel features quantified (MONA REVA 2.1.1 software). Linear stepwise regression (cross-sectional) and linear mixed model (longitudinal) analyses were applied to elucidate independent associations and statistical significance of p < 0.05. Results Population characteristics: The study population was relatively young (HIV-free:44.06±11.09 and HIV+ART:40.35±8.94years) and mostly women (HIV-free:80.7% and HIV+ART:63.1%). The baseline median/mean viral load (VL), CD4 cell count and ART-duration were 50 (10 to 675032) copies mRNA/mL, 539.92±237.16 cells/mm3 and 166 (1 to 707) weeks respectively. Cardiometabolic results: Body mass index (BMI) (24.50±6.65 vs. 28.25±7.68kg/m2, p < 0.001) was significantly lower in HIV+ART vs. HIV-free. ∆BMI in HIV+ART was significantly correlated with average arterial tree diameter (r = 0.323, p < 0.05), total length of skeletonised tree (r = 0.355, p < 0.01) and arteriolar branching angle (r = 0.234, p < 0.05). High density lipoprotein-cholesterol (1.59±0.74 vs. 1.39±0.45mmol/L, p = 0.019) and gamma-glutamyl transferase (GGT) (43.5 (14 to 494) vs. 27.0 (11 to 814)U/L, p < 0.001) were significantly higher in HIV+ART vs. HIV-free, but decreased in HIV+ART (Baseline vs. Follow-up HDL:1.62±0.77 vs. 1.44±0.64mmol/L, p = 0.017 and GGT:45 (14 to 494) vs. 41.50 (14 to 219)U/L, p = 0.004). HDL was significantly correlated with central retinal venular equivalent (CRVE) (r =-0.195, p < 0.01) and GGT with venular branching optimality (r = 0.180, p < 0.05). HIV and ART results: Cross-sectionally, HIV+ART status independently associated with CRVE (-0.146 (- 0.280 to -0.012), p = 0.033) and arteriolar and venular mother branch (D0), first daughter branch (D1) and second daughter branch (D2) (p < 0.05, respectively). VL (-0.198 (-0.025 to -0.001), p = 0.037) and ART- duration (0.188 (0.001 to 0.024), p = 0.047) were independently associated with arteriolar-venular ratio (AVR). Longitudinally, VL independently associated with CRVE (0.096 (0.017 to 0.175), p = 0.018) and AVR (-0.003 (-0.0006 to 0.000003), p = 0.046). CD4 cell count was independently associated with number of branchpoints 0.042 (-0.002 to 0.086), p=0.006) and endpoints (3.0 (0.750 to 5.250), p=0.010). HIV duration independently associated with lacunarity (-0.0080 (-0.0150 to -0.0010), p=0.036) and fractal analyses (0.011 (0.0001 to 0.021), p=0.045). 2nd-line ART was independently associated with CRVE (8.58 (0.35 to 16.81), p=0.041) and ART-duration with fractal analysis (-0.022 (-0.037 to -0.008), p=0.003). Discussion and conclusion HIV+ART appeared to have a more favourable cardiovascular risk profile vs. HIV-free. Various markers of HIV/ART and HIV-ART-associated cardiometabolic risk factors were associated with retinal vessel features and associations appeared mostly favourable/cardioprotective. These results indicate that retinal vessel geometric features may be potential markers of the effects of HIV/ART and/or associated cardiometabolic risk factors in the current study population.