title: Carotid Intima Media Thickness in Mainly Female HIV-Infected Subjects in Rural South Africa: Association With Cardiovascular but Not HIV-Related Factors.
abstract: BACKGROUND
  In sub-Saharan Africa, the number of persons living with human immunodeficiency virus (HIV) has increased immensely. In parallel, rates of noncommunicable diseases, especially cardiovascular disease, are rising rapidly in resource-limited settings. This study aims to evaluate the relation between subclinical atherosclerosis and HIV-related and traditional cardiovascular risk factors in HIV-infected patients in rural South Africa.
  
  
  METHODS
  A cross-sectional study was performed among HIV-infected patients visiting a health center in Limpopo, South Africa. Demographic and HIV-related information was collected, and cardiovascular risk was assessed. Carotid intima media thickness (CIMT) was measured and the prevalence of subclinical atherosclerosis (CIMT >0.78 mm) was calculated. The association between cardiovascular or HIV-related determinants with CIMT was analyzed using linear and logistic regression models adjusted for age and sex.
  
  
  RESULTS
  The median CIMT in 866 subjects (median age [interquartile range], 41 [35-48] years; 69% female) was 0.589 mm (interquartile range, 0.524-0.678 mm), and values seemed higher than in healthy Western reference populations. In fact 12% of subjects (106 of 866) had subclinical atherosclerosis. Hypertension, high body mass index, previous cardiovascular event, diabetes mellitus, total and low-density lipoprotein cholesterol, estimated glomerular filtration rate, metabolic syndrome, and the Framingham Heart Risk score were independently associated with CIMT. No HIV-related determinants were associated with CIMT.
  
  
  CONCLUSIONS
  In a predominantly female HIV-infected population in South Africa, CIMT values are considerably high and associated with cardiovascular risk factors, rather than HIV-related factors. This finding emphasizes the need to screen for cardiovascular disease among persons with HIV infection in resource-limited settings. Ideally, this screening would be integrated into care for chronic HIV infection, posing a major challenge for the future.
authors.affiliation: Department of Internal Medicine and Infectious Diseases.
authors.forename: Annelot F
authors.initials: AF
authors.lastname: Schoffelen
authors.affiliation: Department of ImageLabonline & Cardiovascular, Erichem, The Netherlands.
authors.forename: Eric
authors.initials: E
authors.lastname: de Groot
authors.affiliation: Department of Ndlovu Care Group, Elandsdoorn, Limpopo, South Africa.
authors.forename: Hugo A
authors.initials: HA
authors.lastname: Tempelman
authors.affiliation: Department of Vascular Medicine, University Medical Centre Utrecht.
authors.forename: Frank L J
authors.initials: FL
authors.lastname: Visseren
authors.affiliation: Department of Internal Medicine and Infectious Diseases.
authors.forename: Andy I M
authors.initials: AI
authors.lastname: Hoepelman
authors.affiliation: Department of Internal Medicine and Infectious Diseases.
authors.forename: Roos E
authors.initials: RE
authors.lastname: Barth
mesh_terms: D000328:Adult; D050197:Atherosclerosis / Q000453:epidemiology*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000473:pathology*; D059168:Carotid Intima-Media Thickness; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012424:Rural Population; D013019:South Africa
keywords: HIV; atherosclerosis; cardiovascular risk factors; carotid intima media thickness; sub-Saharan Africa