PEPFAR

Cardiovascular Disease Risk Factor Profiles of HIV-infected Clients: Findings from a pilot program to integrate CVD screening into HIV services at a

secondary health facility in Kano, North-Western Nigeria.

1U.Gwarzo, 1T.Maji, 1S.Isa-Dutse, 1Y.Ahmed, 1K.Obayagbona, 2E. Okechukwu, 1S.Odafe, 1H.Khamofu, 1K.Torpey, 1O.Chabikuli

1FHI 360 Nigeria. 2USAID Nigeria

AIDS 2012 - Turning the Tide Together

BACKGROUND

• Growing evidence from previous studies have shown an increased prevalence of CVD in HIV infected persons

• CVD in HIV infected persons arise from viral effects or antiretroviral medications (ART).

• CVD risk factors, such as Hypertension, hyperlipidaemia, Diabetes Mellitus and Lipodystrophy are seen in HIV infected client

AIM

• To implement a pilot study in a secondary health facility that will assess the feasibility of integrating routine screening for cardiovascular risk factors in an HIV clinic setting, in order to inform programmatic approaches.

Murtala Mohammed Specialist Hospital, Kano

• Located in the Northern Nigeria’s largest city, capital of the most populous state in Nigeria [ 2006 census]

• Established in 1922, >1000 bed capacity • Secondary health facility with about 100 doctors, > 800

nurses and hundreds of supporting staffs • An average of 7,000 General out-patients encounters

daily • Has 6,547 enrolled HIV clients with 3,671 on ART [March

2012]

METHODOLOGY• Cross sectional study involving review of collected patient data• Male & female HIV infected clients enrolled for care between May

2010 - August 2011 were randomly selected for CVD screening using a developed CVD screening tool

• Those identified with specified CVD risk factors were referred for Laboratory evaluation of FBS & Lipid profile

• The 10 year CVD risk of developing a fatal or non-fatal cardiovascular event using the WHO/ISH AFR-D risk assessment charts was then determined for the clients

METHODOLOGY

• Targeted behavioral & biomedical interventions which included referrals to an onsite cardiac clinic were provided for clients with CVD risk of > 20% including bi-annual check

• Follow-up CVD risk assessments were scheduled annually for clients with < 20% CVD risk

Data analysis

• Data was cleaned, coded, entered into Statistical Package for the Social Sciences (SPSS), version 15 (SPSS Inc., Chicago IL).

• Statistical association was determined using Chi- square, One-Way ANOVA and Tuskey Honest Significant Difference

• Outcome variables include distribution of risk factor variables, duration on ART and the value (mean) of Cholesterol, HDL and LDL in both ART and ART naïve clients

RESULTS• A total of 1,033 HIV-positive male and female clients were screened• Age Range: 17 – 70 years• A total of 205 clients (19.8%) had 1 or more risk factors, and sent for

laboratory evaluation• Most common modifiable risk factors identified were:

High BMI: 21.8%Hypertension: 15.2%

• Among those sent for laboratory evaluation:

42% had a CVD risk of < 20%

2.4% had a CVD risk of >/= 20%

Demographic characteristics of the study population

Age-group (yrs)

NON ART RECEIVING ART

Female Male Total Female Male Total

< 25 28 (100%) 0 (0.0%) 28 84 (95.5%) 4 (4.5%) 88

25 - 29 39 (95.1%) 2 (4.9%) 41 180 (90%) 20 (10%) 200

30- 34 29 (78.4) 8 (21.6%) 37 146 (77.2%) 43 (22.8%) 189

35 - 39 20 (66.7%) 10 (33.3%) 30 96 (62.9%) 55 (37.1%) 151

40 - 44 10 (50%) 10 (50%) 20 66 (58.4%) 47 (41.6%) 113

45 - 49 5 (45.5%) 6 (54.5%) 11 23 (41.8%) 32 (58.2%) 55

>50 5 (50%) 5 (50%) 10 32 (55.2%) 26 (44.8%) 58

Frequency distribution of CVD risk factors by ART status

Variables

Totaln (%)

On ARTn (%)

ART naïven (%)

P-value

SexFemale Male

765 (74.1)268 (25.9)

627 (82.2)227 (84.7)

136 (17.8)41 (15.3)

0.35

Age (years)< 40≥ 40

766 (74.3)265 (25.7)

625 (82.2)227 (84.7)

139 (18.2)38 (14.3)

0.15

BMI (kg/m2)<25≥ 25

751 (78.2)209 (21.8)

620 (82.6)177 (85.1)

131 (17.4)31 (14.9)

0.39

Blood pressure (mmHg)≤140/90>140/90

814 (84.8)146 (15.2)

666 (82.0)123 (84.3)

146 (18.0)23 (15.8)

0.52

SmokingYes No

82 (8.0)943 (92.0)

68 (82.9)780 (82.9)

14 (17.1)161 (17.1)

0.99

Analysis of relationship between hyperlipidaemia and duration on treatment

Duration on ART N Mean F Significance

Total Cholesterol

< 1Yr 33 3.93

4.038 0.021-<3Yrs 52 4.49

>=3Yrs 67 4.54

Total 152 4.39

HDL < 1Yr 34 1.10

0.729 0.4841-<3Yrs 52 1.13

>=3Yrs 67 2.25

Total 153 1.61

LDL < 1Yr 33 2.88

0.472 0.6241-<3Yrs 52 3.36

>=3Yrs 67 2.29

Total 152 2.78

RESULTS

• Although all risk factors were more prevalent in those receiving ART, there was no statistical difference with the ART-naïve group

• Mean serum total cholesterol levels were found to increase as duration on ART increased

Discussion

• Developing countries are increasingly facing the double epidemics of CD and NCD, including CVD

• BMI of > 25 kg/m2 found to be 28.1% and BP > 140/90 mmHg found to be 15.2%

• The mean serum total cholesterol levels were observed to increase as the duration on ART increased

CONCLUSION

• We conclude that integration of screening for cardiovascular diseases in ART clinic settings is feasible and essential, in order to improve the life expectancy of HIV-positive individuals.

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