Prevalence and Factors Associated With Carotid Atherosclerosis Among HIV-Infected Outpatient Adults Attending Care and Treatment Clinic CTC at Bugando Medical Centre in Mwanza, Tanzania

Background: HIV infected adults have increased lifetime Cardiovascular Diseases (CVD) risk (Myocardial Infarction (MI), Stroke, and sudden cardiac death) in their lifetime due to complex interaction between CVD risk factors, drug ART toxicity, immune activation, endothelial dysfunction and chronic inflammation inflicted by HIV infection. Despite current scientific understanding of the complex interaction of CVD and HIV, the current Framingham risk score for CVD underestimates the risk of CVD in HIV infected patients. Studies suggest this may be secondary to unmeasured inflammatory components of cardiovascular risk. Whether this inflammatory drive is sufficient to induce accelerated atherosclerotic development or whether this inflammatory drive works synergistically with traditional risk factors remains relatively unstudied. This said, no studies to date have investigated the development of atherosclerosis among HIV-infected ART naïve with and without traditional risk factors especially in low- middle-income countries, either with or without traditional risk factors. Methods: This was a hospital based cross–sectional study performed among HIV-infected patients attending Bugando medical Centre CTC clinic from October 2017 to April 2018. Demographic and HIV-related information was collected, and cardiovascular risk was assessed. Carotid Intima Media Thickness (CIMT) was measured by using high resolution ultrasound and saved still images measured by using Sonosite, M-turbo SonoCalc® IMT software version 5.0 and the prevalence of Carotid Atherosclerosis by measuring CIMT ≥ 0.78 mm was calculated. The association between cardiovascular or HIV-related determinants with CIMT was analyzed using linear and logistic regression models. Results: Of 229 patients, Median age (Interquartile range (IQR)) 36 years (29-43), 174 (75.9%) were females; and 99 (43.2%) were ART-treated for at least 6 months. Overall, 8/220 (3.6%) had Carotid Atherosclerosis; of whom 7/8 (87.5%) were ART naive and were in a group of low risk of developing CVD as estimated by Framingham risk score, whereas 1/8 (12.5%) was ART-experienced. Independent predictors of Carotid Atherosclerosis included older age (odds ratio (OR) 1.12; 95% confidence interval (CI) 1.04-1.22; p=0.003), Systolic BP OR 1.07; CI 1.02-1.11; p=0.002, Male gender (OR 0.17; CI 0.04-0.74, p=0.018), smoking (OR10; CI 2.13-46.89, p=0.003), and higher Framingham risk score (OR 2.05; 1.16-3.61, p=0.012). Conclusion: Overall prevalence of Carotid Atherosclerosis was 3.6% among HIV-infected patients: We had more women participants in our study than men, and most our patients did not have advanced HIV diseases (that is Low CD4, <200 cell/Ul) compared to other studies done in sub-Saharan countries. Smoking, systolic hypertension, older age, male sex and intermediate Framingham risk score was associated with subclinical atherosclerosis in our study rather than HIV-related factors (Diabetes Mellitus, CD4 level, ART regimen, duration of ART use and Viral load).