Cardiovascular risk factors in a treatment-naïve, human immunodeficiency virus-infected rural population in Dikgale, South Africa

Abstract

Objective: The objective was to determine lipid levels and cardiovascular risk factors in treatment-naïve, human
immunodeficiency virus (HIV)-infected rural African people in Limpopo province.
Design: This was a case control study.
Setting and subjects: The setting was Dikgale Health and Demographic Surveillance System Centre, Limpopo province. Treatment naïve, HIV-infected and HIV-negative people participated in the study.
Outcome measures: Demographic, lifestyle and chronic disease data were collected using the World Health Organization stepwise approach to surveillance (STEPS) questionnaire. Biochemical parameters were tested using standard biochemical methods. HIV testing and CD4 counts were performed using the Alere Determine™ HIV 1/2 Ag/Ab kit and The Alere Pima™ Analyser. Insulin resistance, low-density lipoprotein cholesterol (LDL cholesterol), and non-high-density lipoprotein cholesterol (non-HDL cholesterol) levels were calculated.
Results: The mean age of participants (years) was 49.7 ± 16.6. More HIV-infected than HIV-uninfected women consumed alcohol (25.4% vs. 11.9%, p-value < 0.05), and the prevalence of abdominal obesity was higher in HIV-uninfected than in HIV-infected women (74.6% vs. 54.8%, p-value < 0.05). Levels of total cholesterol (TC), HDL cholesterol, non-HDL cholesterol, LDL cholesterol and apolipoprotein A1 (ApoA1) were significantly lower in the HIV-infected than in the HIV-uninfected group. The prevalence of low HDL cholesterol was higher in HIV-infected than in HIV-uninfected people (62.4% vs. 41.6%, p-value < 0.01). HIV infection increased the likelihood of low HDL cholesterol by 2.7 times (p-value 0.001). Male gender and alcohol use decreased the likelihood of low HDL cholesterol by 61% (p-value 0.002) and 48% (p-value 0.048), respectively. HIV infection was associated with low HDL cholesterol, ApoA1, LDL cholesterol and TC. Low CD4 count was associated with low body mass index, LDL cholesterol and high diastolic blood pressure.
Conclusion: The prevalence of cardiovascular risk factors was equally high in HIV-infected and in HIV-uninfected rural people, except for low HDL and alcohol consumption, which were significantly higher in HIV-infected people, while abdominal obesity was significantly higher in HIV-uninfected people. There is a need to raise awareness of cardiovascular risk factors in rural people in Limpopo province.

Keywords: abdominal obesity, alcohol, diabetes, hypertension, lipids