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.