Epidemiology of Coronary Atherosclerosis Among People Living With HIV in Uganda
Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Data on the prevalence of coronary atherosclerotic disease (CAD) in the African region among people with and without HIV are lacking. OBJECTIVE: To estimate the prevalence of CAD in Uganda and determine whether well-controlled HIV infection is associated with increased presence or severity of CAD. DESIGN: Cross-sectional study. SETTING: Southwestern Uganda. PARTICIPANTS: Ambulatory people living with HIV (PWH), aged older than 40 years, taking antiretroviral therapy for 3 or more years, and population-based, age- and sex-similar people without HIV (PWoH). MEASUREMENTS: Participants had cardiovascular (CV) disease (CVD) risk profiling and computed tomography scanning for detection of CAD, defined as the presence of calcified or noncalcified plaque. RESULTS: Of 630 screened, 586 (93%) met criteria and had evaluable images. Of these, 287 (49.0%) were PWH and nearly all (272 of 287 [95%]) were virologically suppressed. Mean age (57.9 vs. 57.4 years), proportion female (49%), and median CVD risk score (4.1 vs. 3.4) did not differ by HIV serostatus. The prevalence of CAD was low overall (45 of 586 [7.7%]) and among both PWH (26 of 287 [9.1%]) and PWoH (19 of 299 [6.4%]; absolute prevalence difference, 2.7% [95% CI, -1.6% to 7.0%]). Results were similar after adjustment for CVD risk factors. LIMITATIONS: Our findings may not generalize to symptomatic populations or those with greater predicted CVD risk. The study was not powered to detect small differences in CAD prevalence between HIV subgroups. Both PWH and PWoH had similar CV risk factor profiles, but residual confounding between HIV and CAD cannot be excluded. CONCLUSION: The prevalence of CAD in Uganda was low compared with population-based cohorts from the Global North with similar CVD risk profiles and was similar between HIV serostatus subgroups. Our results suggest that CAD may not be a major cause of morbidity in Uganda. PRIMARY FUNDING SOURCE: National Institutes of Health.
Source: Annals of Internal Medicine
Authors: Mark J. Siedner, Brian Ghoshhajra, Geoffrey Erem, Rita Nassanga, Mangun Randhawa, Andrew Ochieng, Moses Acan, Michael T. Lu, Vikas Thondapu, Angelo Takigami, Zahra Reynolds, Flavia Atwiine, Edna Tindimwebwa, Rebecca F. Gilbert, Eliza Passell, Shruti Sagar, Yao Tong, Ntobeko A.B. Ntusi, Alexander C. Tsai, Prossy Bibangambah, Thomas Gaziano, Susanne S. Hoeppner, Christopher T. Longenecker, Samson Okello, Stephen Asiimwe
Institutions: Harvard University, Mbarara University of Science and Technology, Massachusetts General Hospital, Africa Health Research Institute, University of KwaZulu-Natal, Nsambya Hospital, Makerere University, Mulago Hospital, Yale University, South African Medical Research Council, University of Cape Town, Brigham and Women's Hospital, University of Washington, University of North Carolina at Chapel Hill
Language: English
Subfield: Emergency Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
Awards: G1342855732, G1391893537, Polycyclic aromatic hydrocarbons exposure and dietary risk of Esophageal squamous cell carcinoma in Uganda, G1698306160, G1857082937, Mentoring in patient-oriented research on the U.S. substance use and HIV syndemic, Pericoronary Adipose Tissue, Inflammation, and Subclinical Coronary Artery Disease in People with HIV in Uganda, Mentoring patient-oriented research to improve cardiovascular health among people with HIV in sub-Saharan Africa, G90079629
OpenAlex ID: W4408346271