title: Subclinical atherosclerosis among HIV-infected adults attending HIV/AIDS care at two large ambulatory HIV clinics in Uganda.
abstract: BACKGROUND
  The increased immune activation and inflammation of chronic HIV-infection and the characteristic dyslipidemias associated with HIV infection and antiretroviral therapy (ART) contribute to an increased risk of atherosclerotic vascular disease among HIV-infected adults. There is an emerging need to understand determinants of cardiovascular disease (CVD) among individuals aging with HIV in sub-Saharan Africa. We determined the prevalence of subclinical atherosclerosis [carotid intima media thickness (CIMT) ≥ 0.78 mm] and its correlation with traditional CVD risk factors among HIV-infected adults.
  
  
  METHODS
  In a cross-sectional study, HIV-infected adults (ART-naïve and ART-treated) were consecutively selected from patients' enrollment registers at two large HIV clinics at Mulago Hospital, Kampala, Uganda. We measured traditional CVD risk factors including age, biophysical profile, fasting blood sugar and serum lipid profile as well as biomarkers of inflammation. High resolution ultrasound was used to measure common carotid CIMT.
  
  
  RESULTS
  Of 245 patients, Median age [Interquartile range (IQR)] 37 years (31-43), 168 (69%) were females; and 100 (41%) were ART-treated for at least 7 years. Overall, 34/186 (18%) had subclinical atherosclerosis; of whom 15/108 (14%) were ART-naïve whereas 19/78 (24%) were ART-treated. Independent predictors of subclinical atherosclerosis included age [odds ratio (OR) 1.83 per 5-year increase in age; 95% confidence interval (CI) 1.24-2.69; p = 0.002], body mass index (BMI); OR 1.15; CI 1.01-1.31; p = 0.041 and high low density lipoprotein (LDL) [OR 2.99; CI 1.02-8.78, p = 0.046]. High sensitivity C-reactive protein (hsCRP) was positively correlated with traditional cardio-metabolic risk factors including waist circumference (r = 0.127, p = 0.05), triglycerides (r = 0.19, p = 0.003) and Total Cholesterol: High Density Lipoprotein ratio (TC:LDL) (r = 0.225, p<0.001).
  
  
  CONCLUSIONS
  The prevalence of subclinical atherosclerosis was 18% among HIV-infected adults in Uganda. Traditional CVD risk factors were associated with subclinical atherosclerosis. We recommend routine assessment of traditional CVD risk factors within HIV care and treatment programs in sub-Saharan Africa.
authors.affiliation: Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: Isaac
authors.initials: I
authors.lastname: Ssinabulya
authors.affiliation: Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: James
authors.initials: J
authors.lastname: Kayima
authors.affiliation: Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America.
authors.forename: Chris
authors.initials: C
authors.lastname: Longenecker
authors.affiliation: Makerere University Joint AIDS program, Kampala, Uganda.
authors.forename: Mary
authors.initials: M
authors.lastname: Luwedde
authors.affiliation: Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda ; Makerere University Joint AIDS program, Kampala, Uganda.
authors.forename: Fred
authors.initials: F
authors.lastname: Semitala
authors.affiliation: Infectious Disease Institute, Makerere University, Kampala, Uganda.
authors.forename: Andrew
authors.initials: A
authors.lastname: Kambugu
authors.affiliation: Department of Radiology, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: Faith
authors.initials: F
authors.lastname: Ameda
authors.affiliation: Department of Radiology, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: Sam
authors.initials: S
authors.lastname: Bugeza
authors.affiliation: Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America.
authors.forename: Grace
authors.initials: G
authors.lastname: McComsey
authors.affiliation: Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: Juergen
authors.initials: J
authors.lastname: Freers
authors.affiliation: Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda ; Infectious Disease Institute, Makerere University, Kampala, Uganda.
authors.forename: Damalie
authors.initials: D
authors.lastname: Nakanjako
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology* / Q000378:metabolism; D000328:Adult; D050197:Atherosclerosis / Q000453:epidemiology* / Q000378:metabolism; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000378:metabolism; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000378:metabolism; D006801:Humans; D008077:Lipoproteins, LDL / Q000378:metabolism; D008297:Male; D012307:Risk Factors; D014454:Uganda
chemical_list: D008077:Lipoproteins, LDL; D002097:C-Reactive Protein