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. 2023 Oct 20;18(1):57.
doi: 10.5334/gh.1264. eCollection 2023.

Prevalence and Determinants of Endothelial Dysfunction among Adults Living with HIV in Northwest Nigeria

Aisha M Nalado  1 , Bala Waziri  2 , Anas Ismail  3 , Nafiu Umar  4 , Zainab U Ibrahim  5 , Patience Obiagwu  6 , Baba M Musa  1 , Mahmoud U Sani  1 , Aliyu Abdu  1 , Faisal S Dankishiya  7 , Mansur A Ramalan  1 , Hadiza Saidu  1 , Usman J Wudil  8 , C William Wester  8 , Muktar H Aliyu  8
Affiliations

Prevalence and Determinants of Endothelial Dysfunction among Adults Living with HIV in Northwest Nigeria

Aisha M Nalado et al. Glob Heart. .

Abstract

Background: Endothelial dysfunction constitutes an early pathophysiological event in atherogenesis and cardiovascular disease. This study aimed to assess the prevalence, determinants, and degree of endothelial dysfunction in antiretroviral therapy (ART)-treated people living with HIV (PLWH) in northwestern Nigeria using brachial flow-mediated dilatation (FMD).

Methods: This was a comparative, cross-sectional study. A total of 200 ART-treated adults living with HIV with no evidence of kidney disease were compared with 200 HIV-negative participants attending a tertiary hospital in Kano, Nigeria, between September 2020 and May 2021. Endothelial function was evaluated by measuring FMD with a high-resolution vascular ultrasound transducer. FMD was calculated as the ratio of the brachial artery diameter after reactive hyperemia to baseline diameter and expressed as a percentage of change. Blood and urine samples were obtained from participants in both arms. Urine albumin-to-creatinine ratio (uACR) was calculated using the 2021 CKD-EPI estimated glomerular filtration rate (eGFR) creatinine-cystatin C equation without the race variable, and low-density lipoprotein (LDL) cholesterol was measured using enzymatic method.

Results: The overall mean age (± standard deviation) of the study participants was 42 ± 11 years. Participants in the comparison arm were younger than PLWH (38 ± 11 versus 46 ± 10 years, respectively). The median (interquartile range) uACR was 41.6 (23.2-162.9) mg/g for the ART-treated PLWH versus 14.5 (7.4-27.0) mg/g for healthy controls. PLWH had a significantly lower mean percent FMD when compared to HIV-negative participants (9.8% ± 5.4 versus 12.1% ± 9.2, respectively). Reduced FMD was independently associated with HIV infection (β = -2.83%, 95% CI, -4.44% to -1.21%, p = 0.001), estimated glomerular filtration rate (β = -0.04%, 95% CI, -0.07% to -0.01%, p = 0.004) and LDL cholesterol (β = -1.12%, 95% CI, -2.13% to -0.11%, p = 0.029).

Conclusion: HIV-positive status, lower estimated GFR, and higher LDL cholesterol levels were independently associated with endothelial dysfunction. Future prospective studies with larger cohorts of persons living with HIV (and age- and sex-matched HIV-negative controls) are needed to gain further insight into these important findings. In the interim, aggressive management of modifiable risk factors is warranted.

Keywords: HIV; cardiovascular disease; endothelial dysfunction; microalbuminuria.

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Conflict of interest statement

The authors have no competing interests to declare.

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