The Burden of Metabolic Diseases Amongst HIV Positive Patients on HAART Attending the Johannesburg Hospital

Henry      Julius; Debashis      Basu; Elena      Ricci; Jeffrey      Wing; Jayati      Kusari Basu; Daria      Pocaterra; Paolo      Bonfanti

doi:10.2174/157016211796320360

Abstract

South Africa has the highest prevalence of human immunodeficiency virus (HIV) infection in the world. The improved life expectancy, due to the recent introduction of highly active antiretroviral therapy (HAART), may lead to an increased health burden related to metabolic disorders, resulting in an increased pressure on health-care services.

The main objective of this study was to determine the prevalence of hypertension, diabetes, obesity and dyslipidemia in a sample of HAART-treated HIV infected patients, attending an HIV clinic in the Gauteng province.

This was a cross-sectional study of 304 HIV positive patients enrolled between January 2009 and March 2009, including patients aged 18 to 45 years, on HAART for more than one year.

Hypertension prevalence was 19.1% (95% confidence interval (CI) 14.7-23.5): 23.9% in men and 17.7% in women (P=0.10). Diabetes was diagnosed in 4 women. Hypercholesterolemia (total cholesterol > 5.00 mmol/mL) was found in 32.2% (95% CI 27.0-37.5), low HDL cholesterol ( < 1.20 mmol/mL) in 45.7% (95% CI 40.1-51.3) and elevated LDL cholesterol ( > 4.10 mmol/mL) in 9.5% (95% CI 6.2-12.8); these prevalences were not different between sexes, whereas hypertriglyceridemia ( > 2.25 mmol(mL) (15.8%, 95% CI 11.7-19.9) was significantly more frequent in men (28.4% versus 12.2%, P=0.002). TC and LDL-C were positively correlated with CD4+ cell count (r=0.13, P=0.03 and r=0.12, P=0.03).

In this sample, the traditional risk factors for cardiovascular disease had a high prevalence, despite the young age of our patients. Women seemed to be at higher risk than man, unlike other HIV populations where these comparisons were made (Uganda, Italy and Norway). Obesity and lipid abnormalities, highly prevalent in the general population, also appeared related to HIV-infection and CD4+ cell count, presumably as a consequence of ART exposure. Further studies are needed in order to survey a population where HIV infection is turning into a chronic disease, with its complications.

Keywords: Dyslipidemia, HAART, HIV, hypertension, prevalence, South Africa, BMI, Anthropometric, HIV-positive, hypercholesterolemia