Figure 1
Flow Chart of SCRIPT stydy participants.
ASCVD; atherosclerotic cardiovascular disease
Table 1
Baseline characteristics of study population.
| HIV–ART– (n = 147) | HIV+ART– (n = 131) | HIV+ART+ (n = 156) | All (n = 434) | P-value | ||
|---|---|---|---|---|---|---|
| Age, years, mean (SD) | 45 (11.9) | 41 (11.1) | 48 (9.1) | 45 (11.0) | <0.001 | |
| Female, n (%) | 108 (73.5) | 89 (67.9) | 111 (71.2) | 308 (71.0) | 0.597 | |
| Marital status, n (%) | Married | 108 (73.5) | 68 (51.9) | 73 (46.8) | 249 (57.4) | <0.001 |
| Single | 38 (25.9) | 53 (40.5) | 59 (37.8) | 150 (34.6) | ||
| Unknown | 1 (0.7) | 10 (7.6) | 24 (15.4) | 35 (8.1) | ||
| Education | None | 10 (6.8) | 17 (13.0) | 25 (16.0) | 52 (12.0) | 0.001 |
| Primary | 85 (57.8) | 84 (64.1) | 106 (67.9) | 275 (63.4) | ||
| Secondary | 31 (21.1) | 16 (12.2) | 21 (13.5) | 68 (15.7) | ||
| Tertiary | 21 (14.3) | 14 (10.7) | 4 (2.6) | 39 (9.0) | ||
| Individual monthly income (GHC) | <500 | 78 (53.1) | 61 (46.6) | 72 (46.2) | 211 (48.6) | 0.179 |
| 500–1000 | 37 (25.2) | 41 (31.3) | 38 (24.4) | 116 (26.7) | ||
| >1000 | 13 (8.8) | 7 (5.3) | 23 (14.7) | 43 (9.9) | ||
| WHO stage, n (%) | Stage I | – | 61 (46.6) | 58 (37.2) | 119 (41.5) | 0.010 |
| Stage II | – | 10 (7.6) | 24 (15.4) | 34 (11.8) | ||
| Stage III | – | 58 (44.3) | 62 (39.7) | 120 (41.8) | ||
| Stage IV | – | 2 (1.5) | 12 (7.7) | 14 (4.9) | ||
| Tobacco Use, n (%) | Current User | 0 (0) | 8 (6.1) | 4 (2.6) | 12 (2.8) | 0.007 |
| Previous user | 4 (2.7) | 7 (5.3) | 11 (7.1) | 22 (5.1) | ||
| Never Used | 143 (97.3) | 116 (88.5) | 141 (90.4) | 400 (92.2) | ||
| Alcohol use, n (%) | Current User | 19 (12.9) | 27 (20.6) | 15 (9.6) | 61 (14.1) | <0.001 |
| Previous user | 16 (10.9) | 39 (29.8) | 53 (34) | 108 (24.9) | ||
| Never Used | 112 (76.2) | 65 (49.6) | 88 (56.4) | 265 (61.1) | ||
| Medications, n (%) | Antihypertensives | 19 (12.9) | 14 (10.7) | 28 (17.9) | 61 (14.1) | 0.188 |
| Anti-diabetics | 4 (2.7) | 6 (4.6) | 2 (1.3) | 12 (2.8) | 0.237 | |
| Statin | 2 (1.4) | 0 (0) | 0 (0) | 2 (0.5) | 0.205 | |
| Aspirin | 1 (0.7) | 3 (2.3) | 4 (2.6) | 8 (1.8) | 0.446 | |
| Current CD4 counts, unit, median, IQR | 253 (111–414) | 623 (378–867) | 401 (206–667) | <0.001 | ||
| Months since HIV diagnosis, median, IQR | 1 (0–2) | 131 (83–158) | 58 (0.8–136) | <0.001 | ||
| Suppressed viremia, n (%) | 7 (6.5) | 104 (70.3) | 111 (43.5) | <0.001 | ||
| Log Viral load in unsuppressed, units, mean (SD) | 11.5 (2.1) | 8.4 (3.1) | 10.5 (2.8) | <0.001 | ||
| Current ART regimen, n (%) | TDF + 3TC + EFZ | 53 (34.0) | 53 (34.0) | NA | ||
| AZT + 3TC + NVP | 39 (25.0) | 39 (25.0) | ||||
| AZT + 3TC + EFZ | 34 (21.8) | 34 (21.8) | ||||
| TDF + 3TC + LPV/r | 11 (7.1) | 11 (7.1) | ||||
| TDF + 3TC + NVP | 7 (4.5) | 7 (4.5) | ||||
| AZT+ 3TC | 2 (1.3) | 2 (1.3) | ||||
| AZT + NVP | 2 (1.3) | 2 (1.3) | ||||
| Other Regimen | 8 (5.1) | 8 (5.1) | ||||
[i] HIV+ART+; HIV patient on anti-retroviral therapy(ART), HIV+ART–; HIV patient not on treatment, HIV–ART–; HIV uninfected individual, WHO stage; World health Organization clinical staging of HIV infection, CD4; cluster of differentiation four T-lymphocytes, TDF, tenofovir; 3TC, Lamivudine; NVP, Nevirapine; AZT, Zidovudine; EFZ, Efavirenz, LPV/r, Lopinavir with low dose ritonavir.
Table 2
Baseline cardiovascular risk factors.
| Risk Factor | HIV–ART– (n = 147) | HIV+ART– (n = 131) | HIV+ART+ (n = 156) | All (n = 434) | P-value | |
|---|---|---|---|---|---|---|
| BMI kg/m2 mean (SD) | 27.4 (5.1) | 23.1 (4.2) | 25.2 (5.6) | 25.3 (5.3) | <0.001 | |
| Waist circumference (cm) mean (SD) | 90 (16.6) | 82 (8.7) | 87 (11.7) | 87 (13.3) | <0.001 | |
| Waist-Hip-Ratio mean (SD) | 0.888 (0.071) | 0.893 (0.067) | 0.904 (0.071) | 0.895 (0.070) | 0.151 | |
| SBP (mmHg) mean (SD) | 134.5 (22.8) | 120.9 (22.6) | 130.6 (23.6) | 129.0 (23.0) | <0.001 | |
| DBP (mmHg) mean (SD) | 82.6 (15.5) | 80.2 (14.1) | 84.4 (14.5) | 82.5 (14.8) | 0.051 | |
| Hypertension pharmacotherapy with control, n (%) | 12 (17.6) | 12 (27.9) | 16 (21.6) | 40 (21.6) | 0.442 | |
| Self-reported comorbidities (n, %) | Hyperlipidemia | 9 (6.1) | 2 (1.5) | 4 (2.6) | 15 (3.5) | 0.104 |
| Hypertension | 25 (17) | 17 (13) | 41 (26.3) | 83 (19.1) | 0.012 | |
| Diabetes | 6 (4.1) | 6 (4.6) | 2 (1.3) | 14 (3.2) | 0.205 | |
| Stroke | 0 (0) | 3 (2.3) | 7 (4.5) | 10 (2.3) | 0.018 | |
| Myocardial infarction | 0 (0) | 1 (0.8) | 4 (2.6) | 5 (1.2) | 0.108 | |
| Heart Failure | 0 (0) | 0 (0) | 1 (0.6) | 1 (0.2) | 1.000 | |
| PAD | 2 (1.4) | 53 (40.5) | 57 (36.5) | 112 (25.8) | <0.001 | |
| Self-reported family history (n,%) | Hyperlipidemia | 2 (1.4) | 1 (0.8) | 3 (1.9) | 6 (1.4) | 0.877 |
| Hypertension | 52 (35.4) | 36 (27.5) | 54 (34.6) | 142 (32.7) | 0.308 | |
| Diabetes | 23 (15.6) | 20 (15.3) | 25 (16.0) | 68 (15.7) | 0.985 | |
| Stroke | 8 (5.4) | 10 (7.6) | 16 (10.3) | 34 (7.8) | 0.295 | |
| Hemoglobin A1c percentage mean (SD) | 5.6 (0.9) | 5.4 (0.6) | 5.3 (0.6) | 5.4 (0.7) | <0.001 | |
| Diabetes mellitus, % (n, %) | 11 (7.5) | 8 (6.1) | 7 (4.5) | 26 (6) | 0.546 | |
| Hs-CRP (mg/L) median (IQR) | 1.00 (0.45–2.74) | 2.03 (0.50–8.58) | 1.70 (0.80–4.50) | 1.60 (0.50–4.10) | 0.003 | |
| Lipoprotein(a) (n, %) | ≥30mg/dL | 83 (62.4) | 58 (48.3) | 108 (69.7) | 249 (61.0) | 0.001 |
| <30mg/dL | 50 (37.6) | 62 (51.7) | 47 (30.3) | 159 (39.0) | ||
| LDL-Cholesterol, mmol/L, mean (SD) | 3.35 (1.07) | 2.75 (0.9) | 3.22 (0.99) | 3.12 (1.02) | <0.001 | |
| LDL-Cholesterol ≥ 3.4 mmol/l (n, %) | 64 (47.8) | 34 (27.4) | 64 (41.8) | 162 (39.4) | 0.003 | |
| HDL-Cholesterol, mmol/L, mean (SD) | 1.36 (0.29) | 1.02 (0.36) | 1.41 (0.33) | 1.28 (0.37) | <0.001 | |
| HDL-Cholesterol ≤ 1.03 mmol/l | 42 (31.3) | 85 (68.5) | 43 (27.7) | 170 (41.2) | <0.001 | |
| Triglyceride, mmol/L median (IQR) | 1.05 (0.7–1.6) | 1.17 (0.9–1.66) | 1.29 (0.92–1.78) | 1.17 (0.84–1.72) | 0.031 | |
| Triglyceride ≥ 1.7 mmol/l | 31 (23.1) | 29 (23.4) | 47 (30.3) | 107 (25.9) | 0.283 | |
| Dyslipidemia, n (%) | 100 (74.6) | 104 (83.9) | 118 (76.1) | 322 (78.0) | 0.158 | |
| 10-year predicted atherosclerotic cardiovascular disease risk score, median (IQR) | 2.8 (0.6–5.2) | 2.1 (0.5–4.3) | 2.7 (0.9–6.6) | 2.6 (0.6–5.5) | 0.115 | |
[i] HIV+ART+; HIV patient on anti-retroviral therapy(ART), HIV+ART–; HIV patient not on treatment, HIV–ART–; HIV uninfected individual. Diabetes mellitus defined as a previous diagnosis of type 1 or 2 diabetes mellitus, at least 2 random blood glucose readings of ≥11.1 mmol/L, fasting plasma glucose reading of ≥7 mmol/L, or self-reported use of a glucose-lowering agent.
Table 3
Distribution of cardiovascular risk per levels of Lp(a) and hs-CRP.
| Risk factor | Lipoprotein(a) | hs-CRP | ||||
|---|---|---|---|---|---|---|
| <30mg/dl | ≥30mg/dl | P-value | <3mg/L | ≥3mg/L | P-value | |
| Sample size | n = 159 | n = 249 | n = 282 | n = 128 | ||
| Systolic BP, mean (SD) | 126.9 (23.1) | 130.1 (23.6) | 0.176 | 130.1 (23.6) | 126.8 (23.9) | 0.200 |
| Diastolic BP, mean (SD) | 80.4 (13.8) | 83.5 (15.4) | 0.041 | 82.4 (15.3) | 82.6 (14.3) | 0.902 |
| Proportion with HPT, n (%) | 61 (38.4) | 113 (45.4) | 0.162 | 116 (41.1) | 61 (47.7) | 0.217 |
| Proportion of HPT on Rx, n (%) | 20 (32.8) | 37 (32.7) | 0.995 | 34 (29.3) | 23 (37.7) | 0.256 |
| Controlled on HPT Rx, n (%) | 11 (18.0) | 26 (23.0) | 0.444 | 19 (16.4) | 19 (31.2) | 0.023 |
| Hemoglobin A1c, mean (SD) | 5.37 (0.56) | 5.50 (0.80) | 0.088 | 5.42 (0.70) | 5.52 (0.74) | 0.162 |
| Proportion with DM | 7 (4.4) | 17 (6.8) | 0.310 | 10 (3.6) | 14 (11.0) | 0.003 |
| Total cholesterol, mean (SD) | 4.7 (1.2) | 5.3 (1.3) | <0.001 | 5.3 (1.2) | 5.4 (1.5) | 0.956 |
| LDL-C, mean (SD) | 2.8 (0.9) | 3.3 (1.0) | <0.001 | 3.1 (1.0) | 3.2 (1.1) | 0.304 |
| HDL-C, mean (SD) | 1.21 (0.38) | 1.32 (0.35) | 0.003 | 1.34 (0.33) | 1.13 (0.42) | <0.001 |
| Triglyceride, median (IQR) | 1.2 (0.8,1.8) | 1.2 (0.9,1.7) | 0.874 | 1.1 (0.8,1.6) | 1.5 (1.0,1.9) | <0.001 |
| Dyslipidemia, n (%) | 119 (74.8) | 199 (80.0) | 0.228 | 203 (72.0) | 117 (91.4) | <0.001 |
| Current Cigarette use | 4 (2.5) | 8 (3.2) | 0.863 | 7 (2.5) | 4 (3.1) | 0.456 |
| Previous Cigarette Use | 9 (5.7) | 12 (4.8) | 12 (4.3) | 9 (7.0) | ||
| Body Mass Index, mean (SD) | 25.2 (5.6) | 25.5 (5.3) | 0.610 | 25.1 (4.7) | 26.0 (6.7) | 0.105 |
| Waist-to-Hip ratio, median (SD) | 0.90 (0.06) | 0.89 (0.07) | 0.479 | 0.88 (0.07) | 0.91 (0.06) | 0.002 |
| Peripheral Artery Disease | ||||||
| Normal | 63 (37.1) | 107 (62.9) | 0.287 | 126 (74.1) | 44 (25.9) | 0.387 |
| 0.81–0.9 (Mild) | 27 (40.3) | 40 (59.7) | 42 (63.6) | 24 (36.4) | ||
| 0.5–0.8 (moderate) | 15 (25) | 45 (75) | 40 (66.7) | 20 (33.3) | ||
| ≤0.49 (severe) | 4 (33.3) | 8 (66.7) | 8 (66.7) | 4 (33.3) | ||
| Metabolic syndrome, n (%) | 63 (39.6) | 92 (37.0) | 0.587 | 92 (32.6) | 65 (50.8) | <0.001 |
| Study group | ||||||
| Control | 50 (37.6) | 83 (62.4) | 0.001 | 106 (79.7) | 27 (20.3) | 0.001 |
| Naïve | 62 (51.7) | 58 (48.3) | 72 (58.5) | 51 (41.5) | ||
| ART | 47 (30.3) | 108 (69.7) | 104 (67.5) | 50 (32.5) | ||
Table 4
Factors associated with high concentrations of Lp(a) and hs-CRP.
| HIV Positive | Lipoprotein(a) ≥ 30mg/dl | Hs-CRP (>3mg/L) | ||
|---|---|---|---|---|
| OR (95%CI) | p-Value | OR (95%CI) | p-Value | |
| Model 1 | 0.92 (0.60–1.40) | 0.025 | 2.25 (1.38–3.67) | <0.001 |
| Model 2 | 0.56 (0.34–0.93) | 0.024 | 2.78 (1.60–4.84) | <0.001 |
| Model 3 | 0.58 (0.35–0.97) | 0.039 | 3.19 (1.80–5.65) | <0.001 |
| Model 4 | 0.44 (0.24–0.80) | 0.006 | 3.31 (1.68–6.52) | <0.001 |
| Model 5 | 0.46 (0.25–0.84) | 0.012 | 3.34 (1.67–6.67) | <0.001 |
| On ART | OR (95%CI) | p-Value | OR (95%CI) | p-Value |
| Model 1 | 1.83 (1.20–2.79) | <0.001 | 1.10 (0.71–1.69) | 0.123 |
| Model 2 | 2.46 (1.50–4.03) | <0.001 | 0.68 (0.41–1.11) | 0.123 |
| Model 3 | 2.45 (1.46–4.11) | <0.001 | 0.57 (0.34–0.96) | 0.033 |
| Model 4 | 2.72 (1.56–4.76) | <0.001 | 0.63 (0.36–1.11) | 0.111 |
| Model 5 | 2.67 (1.53–4.68) | <0.001 | 0.66 (0.37–1.19) | 0.167 |
[i] Model 1 – HIV positive only or ART only as predictors.
Model 2–HIV positive and ART as predictors.
Model 3–HIV positive, ART, age and sex.
Model 4–HIV positive, ART, age, sex, Blood pressure, Dyslipidemia, Diabetes Mellitus, Waist-Hip ratio, tobacco use, metabolic syndrome and Body Mass Index as predictors.
Model 5–HIV positive, ART, age, sex, Blood pressure, Dyslipidemia, Diabetes Mellitus, Waist-Hip ratio, tobacco use, metabolic syndrome, Body Mass Index and either hs-CRP or Lp(a) as predictors.