Cardiovascular Disease Risk from Protease Inhibitors-ART for HIV: Retrospective Cohort of University Teaching Hospital, Zambia

The burden of Cardiovascular Disease (CVD) in Sub-Saharan Africa is rising amidst a high prevalence of infectious diseases including HIV. While use of certain Antiretroviral Therapy (ART) drugs has been shown to cause dyslipidaemia, little is known about the burden of CVD in the presence of Protease Inhibitors (PIs) in Sub-Saharan Africa. We investigated the incidence and risks associated with the use of PI-containing ART in the development of CVD among HIV seropositive adults at the University Teaching Hospital, Zambia. For this purpose a retrospective cohort study was used to review records of patients on PIs and non PIs between January 2008 and January 2016. The end point of the study was CVD (n=281). Generalized linear models using a log-binomial link were used to assess covariates, while Kaplan Meier method for probability of survival to CVD and time to CVD comorbidity were utilised. The results showed that the incidence of CVD among PIs was 62%, while among the non-PI ART group it was 38%. The risk of CVD was 2.3 times higher (p<0.001; 95% CI: 1.86-2.81) in the PIs ART group than non-PI ART group. Risk factors included; Age, CD4 cell count, Type of ART, Years since HIV diagnosis and BMI, with the CVD attributable risk of 56%. The Kaplan-Meier survival estimates for CVD showed a marked difference in survivorship between the two ART groups (Log-rank P=0.003). Based on this therefore, prolonged use of PI-containing ART was significantly associated with a higher incidence of CVD. Addressing the modifiable risk factors could significantly contribute towards reduction of CVD in the HIV population. This study underscores the importance of new screening strategies to be effectively incorporated in ART program. However, many opportunities exist for developing interventions for optimal screening, treatment and prevention of CVD in patients on ART.