title: Cardiovascular risk factors in adult Malawians on long-term antiretroviral therapy.
abstract: Around 225,000 patients currently receive antiretroviral therapy (ART) in the Malawi scale-up programme that uses the public health approach to ART. There are concerns that cardiovascular disease risk factors are common in ART patients, but few data exist from sub-Saharan Africa, and none from Malawi. We did a cross-sectional study of cardiovascular risk factors in urban, adult, Malawian ART patients, with the WHO STEP-wise surveillance tool. We enrolled 174 long-term (>1 year) ART patients during routine clinic visits, mean age 40.8 years (range 18-69), 61.5% female, 97.1% on first-line regimens, median duration ART 35.5 months. Insufficient fruit and vegetable diet (67.6%), raised blood pressure (45.9%), increased waist-hip ratio (45.4%), raised total cholesterol levels (31.0%) and low physical activity level (27.0%) were common, while current smoking (0.6%), current alcohol consumption (2.3%) and elevated glucose levels (1.2%) were rare. In multivariable analyses, higher age was associated with low physical activity, raised blood pressure, being overweight, and increased waist-hip ratio. Longer duration of ART was not associated with any risk factor and was protective for being overweight. Cardiovascular risk factors were common among long-term ART patients in Malawi. This requires more attention and further study in programmes using the public health approach to ART.
authors.affiliation: Department of Medicine, University of Malawi, College of Medicine, Private Bag 360, Blantyre 3, Malawi.
authors.forename: William
authors.initials: W
authors.lastname: Muronya
authors.forename: Esther
authors.initials: E
authors.lastname: Sanga
authors.forename: George
authors.initials: G
authors.lastname: Talama
authors.forename: Johnstone J
authors.initials: JJ
authors.lastname: Kumwenda
authors.forename: Joep J
authors.initials: JJ
authors.lastname: van Oosterhout
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D050197:Atherosclerosis / Q000150:complications / Q000453:epidemiology* / Q000209:etiology*; D003430:Cross-Sectional Studies; D005247:Feeding Behavior; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology*; D006801:Humans; D006937:Hypercholesterolemia / Q000150:complications / Q000453:epidemiology; D006973:Hypertension / Q000150:complications / Q000453:epidemiology; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D050177:Overweight / Q000150:complications / Q000453:epidemiology; D012307:Risk Factors; D057185:Sedentary Behavior; D014504:Urban Health; D014505:Urban Population / Q000706:statistics & numerical data; D049629:Waist-Hip Ratio
chemical_list: D019380:Anti-HIV Agents