Evaluation of biochemical markers of cardiac risk in antiretroviral therapy (ART) -Treated HIV-Infected adults in Rwanda

Abstract

Background: Similar to other African countries, life expectancy of people living with HIV infection has improved due to access to antiretroviral therapy (ART) in Rwanda. However, both HIV infection and use of ART are associated with cardiovascular disease (CVD) risks, due to adverse changes in some biochemical markers, causing dyslipidemia and other metabolic imbalances. Biomarkers for CVD risk in HIV-infected individuals taking ART, has not been well characterized in Rwanda. We evaluated the association between the use and duration of ART and biomarkers of CVD risk among HIV infected adults in Rwanda. Methods: A total of 150 participants (18-45 years) from HIV clinics in public Health Center in Kigali included n=30 HIV-uninfected (HIV-) and n=120 HIV-infected (HIV+) adults. Among the HIV+ adults, n=40 participants were ART-naïve. Cross-sectional data were collected on health-related behaviors and biochemical markers of CVD risk. We compared CVD-related biochemical markers between HIV-, HIV+ ART-naïve and HIV+ on ART groups. Results: The majority of participants were women (60%) and HIV- were younger (35±6 vs. 31±6 years). Total cholesterol and triglycerides concentrations were associated with ART usage. Serum triglycerides concentrations were lower in HIV+ ART-naïve compared to HIV+ on ART (76.6±38.9 mg/dl vs. 85.0±38.3 mg/dl; p< 0.01). While total cholesterol concentrations was higher in HIV+ on ART than HIV+ ART-naïve (136.0±45.1 mg/dl vs. 130.0±36.5 mg/dl; p<0.04), HDL-C was higher in those taking ART (68.7±30.0 mg/dl vs. 55.0±25.7 mg/dl; p=0.02) among HIV+ on ART for 0-6 months and 7-12 months respectively. Conclusion: Higher serum total cholesterol and triglycerides were associated with use of ART in young adults with HIV. Although these values were within the upper limits of normal, our findings suggest early alterations in biomarkers of cardiac risk. These findings underscore the need for early evaluation of lipid proles as biomarkers of cardiovascular disease risk, to effectively monitor how ART may contribute to cardiovascular disease and deter treatment programs in African countries.