Detection of undiagnosed elevated cardiac risk biomarkers in HIV-positive patients on antiretroviral therapy (ART) from seven health centers in Kigali-City, Rwanda

Abstract

Background: The life expectancy of people living with HIV infection in Rwanda has improved due to access to antiretroviral therapy (ART). Both HIV infection and use of ART have been associated with cardiovascular disease (CVD) due to adverse biochemical changes. The effect of these drugs on cardiac biomarkers in HIV-infected individuals has not been well characterized in Rwanda. Objectives: To determine demographic and life style CVD risk factors among HIV- infected study participants. To assess the relationship between ART use and changes in biochemical markers of CVD risk among HIV infected adults in Kigali city, Rwanda. Methods: A total of 150 participants (18-45 years) from HIV clinics in public Health Centers in Kigali city 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 (NT-proBNP, hs-CRP, TC, HDL-C, LDL-C, TG, and glucose). We compared CVD-related biochemical markers between HIV-, HIV+ ART-naïve and HIV+ on ART groups Data analysis: Data obtained from the questionnaire and biochemical assays, coded and stored in Microsoft Access and was analyzed using Statistical packages for social sciences (SPSS) version 27.0. Descriptive analysis from categorical variables were presented using frequencies and proportions while continuous variables were analyzed for means and standard deviation. Chi-square test was used to check for associations between categorical variables and the significance threshold was considered for a p-value of <0.05. The mean of biochemical markers was compared using independent t-test and Analysis of Variance (ANOVA). Significance difference was considered for a p-value <0.05 with corresponding 95% confidence interval. The association between biochemical markers and ART use was assessed using linear regression with Pearson Correlation test and significance threshold set to p<0.05. Results: Majority of participants were women (60%), and HIV uninfected were younger (35±6 vs. 31±6 years). Total cholesterol and triglycerides concentrations were associated with use of ART. Serum triglycerides concentrations were lower in HIV+ ART-naïve compared to HIV+ on ART (61.20±18.30 mg/dl vs. 85.00±38.30 mg/dl; p< 0.01). While total cholesterol concentrations was higher in HIV+ on ART than HIV+ ART-naïve (136.00±45.00 mg/dl vs. 119.00±36.00 mg/dl; p<0.04). HDL-C was higher in those taking ART (68.70±30.00 mg/dl vs. 55.00±25.70 mg/dl; p=0.03) among HIV+ on ART for 0-6 months and 7-12 months respectively. The cardiac specific biomarker of NT-ProBNP were more frequently distributed among HIV positive patients on longer ART treatment (25% versus 23%), 7-12 months as opposed to those on ART from 0-6 months; (p=0.05) . hs-CRP levels were not significantly different across the groups. Conclusion: Cardiac risk biomarker profiles, NT-proBNP and lipid panel (cholesterol and triglycerides) should be more frequently assessed to timely identify undiagnosed elevated levels in ART-treated HIV-positive patients so that duly management and treatments of CVDs among patients in health centers and HIV clinics can be optimally implemented. Recommendation: There is need for systematic evaluation of cardiac risk biomarker profiles among HIV-positive patients on ART. The current study suggests early alterations in cardiac and other CVD risk markers accompanying ART usage.