Prevalence and Determinants of Subclinical Atherosclerosis in People Living with HIV on Antiretroviral Treatment in Hospitals in Kinshasa

Abstract

Introduction: The objective of this work was to identify the traditional, emerging, and therapeutic cardiometabolic risk factors for subclinical atherosclerosis in human immunodeficiency virus (HIV)-infected patients under antiretroviral treatment in the era of dolutegravir (DGT) in hospitals in the Kinshasa, Democratic Republic of the Congo (DRC).
Methods: This was a descriptive and analytical cross-sectional study held between January 2017 and December 2021 among people living with HIV (PLWHIV) on antiretroviral treatment (ART) for at least 6-months, supported in the structures of the Network Catholic of the Diocesan Office of Medical Works (BDOM) and at the University Clinics of Kinshasa (UCK). Sub clinical atherosclerosis was defined by: pulse pressure (PP)≥60 mm Hg; a carotid intima-media thickness (CIMT)>0.8 mm and a systolic pressure index (SPI)<0.9. Logistic regression was used in the statistical study of associations.
Results: A total of 321 PLWHIV on ART were recruited. The average age of PLWHIV was 51±11-years with a female pre dominance of 72% (n=231); the independent determinants of subclinical atherosclerosis were married (aOR: 4, 95% CI 1.5 10.5; p<0.006), low socio-economic status (aOR: 10.7, 95% CI 2.3-48, 7 p<0.002), duration of HIV infection (ORa: 6.6, 95% CI 2.8-16; p<0.0001), duration of antiretroviral treatment ≥9-years (ORa: 0, 3, 95% CI 0.2-0.7; p<0.005) and the total cholesterol/high-density lipoprotein-cholesterol ratio (CT/HDL-C) (ORa: 2, 95% CI 1.1-3.6; p=0.034). Dyslipidaemia (hyper low-density lipoprotein-cholesterol (LDL-C), hyper HDL-c and hypertriglyceridemia) has been identified in PLWHIV on DTG. The prevalence of subclinical atherosclerosis in PLWHIV on ART was 31.1% (n=116/321).
Conclusion: Married people, low socioeconomic level, duration of HIV infection, duration of antiretroviral treatment beyond 9-years, and the CT/HDL-C ratio are identified as independent determinants of subclinical atherosclerosis in PLWHIV on ART in Kinshasa hospitals. Dyslipidemia is found in PLWHIV on DTG and the prevalence of subclinical atherosclerosis among PLWHIV on ART is low compared to that of Côte d’Ivoire.