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. 2017 Dec 15;17(1):954.
doi: 10.1186/s12889-017-4940-1.

The association between HIV and atherosclerotic cardiovascular disease in sub-Saharan Africa: a systematic review

Emily P Hyle  1   2   3 , Bongani M Mayosi  4 , Keren Middelkoop  5 , Mosepele Mosepele  6   7 , Emily B Martey  8 , Rochelle P Walensky  8   9   10   11   12   13 , Linda-Gail Bekker  5 , Virginia A Triant  9   10   13
Affiliations

The association between HIV and atherosclerotic cardiovascular disease in sub-Saharan Africa: a systematic review

Emily P Hyle et al. BMC Public Health. .

Abstract

Background: Sub-Saharan Africa (SSA) has confronted decades of the HIV epidemic with substantial improvements in access to life-saving antiretroviral therapy (ART). Now, with improved survival, people living with HIV (PLWH) are at increased risk for non-communicable diseases (NCDs), including atherosclerotic cardiovascular disease (CVD). We assessed the existing literature regarding the association of CVD outcomes and HIV in SSA.

Methods: We used the PRISMA guidelines to perform a systematic review of the published literature regarding the association of CVD and HIV in SSA with a focus on CVD surrogate and clinical outcomes in PLWH.

Results: From January 2000 until March 2017, 31 articles were published regarding CVD outcomes among PLWH in SSA. Data from surrogate CVD outcomes (n = 13) suggest an increased risk of CVD events among PLWH in SSA. Although acute coronary syndrome is reported infrequently in SSA among PLWH, limited data from five studies suggest extensive thrombus and hypercoagulability as contributing factors. Additional studies suggest an increased risk of stroke among PLWH (n = 13); however, most data are from immunosuppressed ART-naïve PLWH and thus are potentially confounded by the possibility of central nervous system infections.

Conclusions: Given ongoing gaps in our current understanding of CVD and other NCDs in PLWH in SSA, it is imperative to ascertain the burden of CVD outcomes, and to examine strategies for intervention and best practices to enhance the health of this vulnerable population.

Keywords: Africa; Atherosclerosis; CVD; HIV; Review.

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Not applicable.

Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Flow diagram for the selection of studies. We followed PRISMA guidelines for screening articles in the systematic review. We identified articles via a systematic search of the PubMed database and derived additional records from reference lists of previously identified articles or co-author input. Articles were screened first by title, then by abstract, and finally on explicit inclusion/exclusion criteria. Full-text articles considered eligible for inclusion were categorized based on emphasis of CVD risk factors, biomarkers of immune status and endothelial activation, surrogate CVD outcomes, acute coronary syndrome, and stroke
Fig. 2
Fig. 2
Publication year for studies on HIV and CVD risk factors and outcomes in sub-Saharan Africa. Full-text articles were stratified by year of publication and description of CVD risk factors, biomarkers of immune status and endothelial activation, surrogate CVD outcomes, acute coronary syndrome, or stroke. Of the 166 studies assessed in this review, the majority (n = 102) were published between 2013 and 2016. Only 3 months of 2017 publications were included
See this image and copyright information in PMC

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