HIV and ART status at baseline are associated longitudinally with increased pulse wave velocity: findings from the Ndlovu cohort study

Objective(s): People living with HIV (PLWH) have an increased risk of cardiovascular disease (CVD), but longitudinal data from middle-income settings remain limited. This study examined the association between HIV, antiretroviral therapy (ART), and pulse wave velocity (PWV), a marker of arterial stiffness and CVD risk. Design: A longitudinal analysis from the Ndlovu Cohort Study, South Africa. Methods: The study included 705 participants (325 PLWH, 81% on ART at baseline, 19% initiating ART at baseline, and 380 HIV-negative people. Demographic data, HIV/ART status, and covariates were collected at baseline, while PWV was measured at 12 and 36 months. Mixed-effects models were used to analyse PWV changes over time, adjusting for age, sex, and systolic blood pressure (SBP). Results were reported as beta coefficients (β) with 95% confidence intervals (CI). Results: At baseline, PLWH were older and predominantly female (67%) compared to HIV-negative people. At 12 months, median PWV was higher in PLWH (7.3 m/s) than in HIV-negative people (7.0 m/s, p=0.001). Over 36 months, PWV increased by 0.30 m/s in PLWH and 0.20 m/s in HIV-negative people (p = 0.002). ART-naïve individuals had the largest PWV increase after starting ART (6.8 m/s at 12 months to 7.4 m/s at 36 months, p = 0.001). HIV (β=0.65, 95% CI: 0.24–1.06, p = 0.002) and time (β=0.31 m/s per year, p < 0.001) were significantly associated with higher PWV. Conclusions: PWV increased over time, particularly in PLWH, with ART initiation linked to rapid increases. These findings highlight the need for early CVD risk monitoring, especially post-ART initiation, in resource-limited settings.