PREVALENCE OF CARDIOMETABOLIC DISEASE RISK FACTORS IN PEOPLE LIVING WITH HIV INITIATING ANTI-RETROVIRAL THERAPY AT A HIGH-VOLUME HIV CLINIC IN KAMPALA, UGANDA

Abstract

Therapeutic Area: Cardiovascular diseases among Persons Living With HIV Background: Cardiometabolic diseases are a leading cause of HIV-related morbidity and mortality, yet HIV treatment programs in high burden countries have been slow to implement early screening for people living with HIV (PLHIV) initiating antiretroviral therapy (ART). This study aimed to assess the prevalence and risk factors of the metabolic syndrome (MetS) and its components in a cohort of Ugandan PLHIV initiating ART in Kampala, Uganda. Methods: We used baseline sociodemographic and clinical data to conduct a cross-sectional study of adult PLHIV aged ≥ 18 years enrolled in the GLUMED (Glucose metabolism changes in Ugandan HIV patients on Dolutegravir) Study from January to October 2021. MetS was defined as having at least 3 of the following: abdominal obesity measured by waist circumference, hypertension (HTN), elevated fasting glucose, elevated triglycerides, and low high-density lipoprotein cholesterol. Dyslipidemia was defined as derangement in any of the components of the lipid panel. Multivariate logistic regression was used to assess associations between potential risk factors and MetS and its components. Results: A total of 309 ART naïve PLHIV were analyzed, 59.2% of whom were female. The median age was 31 years and median CD4 count was 318 cells/mm3. The prevalence of MetS was 13.9%. The most common cardiometabolic risk factors were dyslipidemia (93.6%), abdominal obesity (34.0%), hyperglycemia (18.4%), and hypertension (8.1%). Notwithstanding, only 1.8% of the patients above 30 years (170/309 (55%)) had a 10-year cardiovascular disease risk exceeding 10%. In adjusted regression analysis, MetS was associated with age > 40 years (Adjusted Odds Ratio, (AOR) 3.33, 95% confidence interval (CI) 1.45-7.67) and CD4 count > 200 cells/mm3 (AOR 3.79, 95% CI 1.23-11.63). HTN was associated with age > 40 years (AOR 2.96, 95% CI 1.32-6.64), and dyslipidemia was associated with urban residence (AOR 4.99, 95% CI 1.35-18.53). There were no independent predictors of hyperglycemia. Conclusions: Cardiometabolic risk factors were common in this young Ugandan cohort of PLHIV initiating dolutegravir-based ART, underscoring the need for programmatic implementation of surveillance and management of comorbidities in Uganda and similar settings.