Prevalence and risk factors for peripheral arterial disease among HIV infected patients at the Moi Teaching and Referral Hospital, Eldoret, Kenya

Abstract

Background: According to the United Nations programme on HIV/AIDS (UNAIDS 2017 Data book), Kenya has the fourth highest HIV infection burden in the world with majority of her HIV infected adult population on antiretroviral therapy (ART). Studies have shown that HIV infection and use of ART predispose to peripheral arterial disease (PAD), which is the narrowing and occlusion of arteries of the lower limbs mainly by atherosclerotic plaques. PAD is associated with major acute cardiovascular events and physical disability. Studies in High Income Countries have reported high prevalence of PAD in HIV infected population. However, prevalence in Kenya and sub-Saharan Africa has not been well described. Early detection of PAD leads to successful management and prevention of complications. Objective: To compare the prevalence of peripheral arterial disease and associated risk factors in HIV infected versus non-HIV infected patients matched for age and sex. Methods: This was a cross-sectional study conducted at the Moi Teaching and Referral Hospital (MTRH). The study population was all HIV infected and non-HIV infected patients aged ≥18 years in the Academic Model Providing Access to Healthcare (AMPATH) modules, adult medical wards and medical outpatient clinics at MTRH. A total of 235 study participants were enrolled by systematic random sampling between March and May 2017. An interviewer administered structured questionnaire was used to collect socio-demographic and clinical data. The Edinburgh Claudication Questionnaire (ECQ) and Ankle Brachial Index (ABI) were used as study tools (whereby, resting and post ABI squatting exercise measurements were taken). Blood samples were also collected for measurement of glycated haemoglobin and cholesterol levels. Data was analysed for prevalence with statistical significance set at p<0.05. Results: A total of 235 participants were included in the final analysis, 118 HIV infected and117 non-HIV infected. Claudication suggestive of PAD was reported using ECQ in 20.3% of HIV infected compared to 6.8% of non-HIV infected participants (P = 0.003). Low ABI suggestive of PAD (ABI≤ 0.9 or >15% absolute drop on exercise) was reported in 18.0% of HIV infected compared to 2.6% of non-HIV infected participants (P < 0.001). The participants who had PAD tended to have the following predominant risk factors: being old (median age 46 IQR: 11), female (72.0%), having dysglycaemia (75.0%), high viral load (58.3%), being on second line ART (58.3%), overweight (56.2%), having dyslipidaemia (37.5%), and hypertension (25.0%). Conclusion: There is a high prevalence of PAD as measured by ABI and ECQ in HIV infected compared to non-HIV infected adults in a tertiary medical centre in western Kenya. Recommendation: Routine individualized screening of PAD, in those with more than one risk factor, based on guidelines by AHA/ACC, and monitoring of potential risk factors in HIV infected population.