title: HIV and risk of cardiovascular disease in sub-Saharan Africa: Rationale and design of the Ndlovu Cohort Study.
abstract: Background The largest proportion of people living with HIV resides in sub-Saharan Africa (SSA). Evidence from developed countries suggests that HIV infection increases the relative risk of cardiovascular disease (CVD) by up to 50%. Differences in lifestyle, gender distribution, routes of HIV transmission and HIV subtype preclude generalisation of data from Western countries to the SSA situation. The Ndlovu Cohort Study aims to provide insight into the burden of cardiovascular risk factors and disease, the mechanisms driving CVD risk and the contribution of HIV infection and its treatment to the development of CVD in a rural area of SSA. Design The Ndlovu Cohort Study is a prospective study in the Moutse area, Limpopo Province, South Africa. Methods A total of 1000 HIV-positive and 1000 HIV-negative participants aged 18 years and older with a male to female ratio of 1:1 will be recruited. Measurements of CVD risk factors and HIV-related characteristics will be performed at baseline, and participants will be followed-up over time at 6-month intervals. The burden of CVD will be assessed with repeated carotid intima-media thickness and pulse wave velocity measurements, as well as by recording clinical cardiovascular events that occur during the follow-up period. Conclusion This project will contribute to the understanding of the epidemiology and pathogenesis of CVD in the context of HIV infection in a rural area of SSA. The ultimate goal is to improve cardiovascular risk prediction and to indicate preventive approaches in the HIV-infected population and, potentially, for non-infected high-risk populations in a low-resource setting.
authors.affiliation: 1 Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.|2 Department of Internal Medicine & Infectious Diseases, University Medical Center Utrecht, The Netherlands.|3 Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Alinda
authors.initials: A
authors.lastname: Vos
authors.affiliation: 4 Ndlovu Care Group, Groblersdal, South Africa.
authors.forename: Hugo
authors.initials: H
authors.lastname: Tempelman
authors.affiliation: 1 Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.|4 Ndlovu Care Group, Groblersdal, South Africa.
authors.forename: Walter
authors.initials: W
authors.lastname: Devillé
authors.affiliation: 2 Department of Internal Medicine & Infectious Diseases, University Medical Center Utrecht, The Netherlands.
authors.forename: Roos
authors.initials: R
authors.lastname: Barth
authors.affiliation: 5 Clinical Virology, Medical Microbiology, University Medical Center Utrecht, The Netherlands.
authors.forename: Annemarie
authors.initials: A
authors.lastname: Wensing
authors.affiliation: 1 Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.|6 Center for Infectious Disease Control, RIVM, Bilthoven, The Netherlands.
authors.forename: Mirjam
authors.initials: M
authors.lastname: Kretzschmar
authors.affiliation: 1 Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.|7 Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Klipstein-Grobusch
authors.affiliation: 2 Department of Internal Medicine & Infectious Diseases, University Medical Center Utrecht, The Netherlands.
authors.forename: Andy
authors.initials: A
authors.lastname: Hoepelman
authors.affiliation: 8 Laboratory of Translational Immunology, University Medical Center Utrecht, The Netherlands.
authors.forename: Kiki
authors.initials: K
authors.lastname: Tesselaar
authors.affiliation: 4 Ndlovu Care Group, Groblersdal, South Africa.
authors.forename: Sue
authors.initials: S
authors.lastname: Aitken
authors.affiliation: 4 Ndlovu Care Group, Groblersdal, South Africa.
authors.forename: Mashudu
authors.initials: M
authors.lastname: Madzivhandila
authors.affiliation: 1 Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.
authors.forename: Cuno
authors.initials: C
authors.lastname: Uiterwaal
authors.affiliation: 3 Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Francois
authors.initials: F
authors.lastname: Venter
authors.affiliation: 1 Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.
authors.forename: Roel
authors.initials: R
authors.lastname: Coutinho
authors.affiliation: 1 Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.|9 Julius Clinical Research, Academic Contract Research Organization, Zeist, The Netherlands.
authors.forename: Diederick E
authors.initials: DE
authors.lastname: Grobbee
mesh_terms: D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D059168:Carotid Intima-Media Thickness; D003906:Developing Countries; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D008297:Male; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D063177:Pulse Wave Analysis; D012107:Research Design; D018570:Risk Assessment; D012307:Risk Factors; D012423:Rural Health; D013019:South Africa / Q000453:epidemiology; D011795:Surveys and Questionnaires; D013997:Time Factors; D059289:Vascular Stiffness
keywords: Human immunodeficiency virus; cardiovascular disease; cardiovascular risk factors; carotid intima–media thickness measurement; cohort study; pulse wave velocity