Epidemiology of Coronary Atherosclerosis Among People Living With HIV in Uganda : A Cross-Sectional Study

Mark J Siedner¹, Brian Ghoshhajra², Geoffrey Erem³, Rita Nassanga³, Mangun Randhawa⁴, Andrew Ochieng⁵, Moses Acan⁶, Michael T Lu², Vikas Thondapu⁷, Angelo Takigami⁴, Zahra Reynolds⁴, Flavia Atwiine⁶, Edna Tindimwebwa⁸, Rebecca F Gilbert⁴, Eliza Passell⁴, Shruti Sagar⁴, Yao Tong⁴, Ntobeko A B Ntusi⁹, Alexander C Tsai¹⁰, Prossy Bibangambah⁶, Thomas Gaziano¹¹, Susanne S Hoeppner², Christopher T Longenecker¹², Samson Okello¹³, Stephen Asiimwe¹⁴

Affiliations

¹ Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Mbarara University of Science and Technology, Mbarara, Uganda; Africa Health Research Institute, KwaZulu-Natal, South Africa; and University of KwaZulu-Natal, Durban, South Africa (M.J.S.).
² Massachusetts General Hospital, Boston; and Harvard Medical School, Boston, Massachusetts (B.G., M.T.L., S.S.H.).
³ Makerere University, Kampala; and Nsambya Hospital, Kampala, Uganda (G.E., R.N.).
⁴ Massachusetts General Hospital, Boston, Massachusetts (M.R., A.T., Z.R., R.F.G., E.P., S.S., Y.T.).
⁵ Nsambya Hospital, Kampala; and Mulago National Referral Hospital, Kampala, Uganda (A.O.).
⁶ Mbarara University of Science and Technology, Mbarara, Uganda (M.A., F.A., P.B.).
⁷ Yale University School of Medicine, New Haven, Connecticut (V.T.).
⁸ Kabwohe Clinical Research Center, Kabwohe, Sheema, Uganda (E.T.).
⁹ Department of Medicine, University of Cape Town, Cape Town; and the South African Medical Research Council, Cape Town, South Africa (N.A.B.N.).
¹⁰ Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Mbarara University of Science and Technology, Mbarara, Uganda; and Harvard T.H. Chan School of Public Health, Boston, Massachusetts (A.C.T.).
¹¹ Harvard Medical School, Boston; Harvard T.H. Chan School of Public Health, Boston; and Brigham and Women's Hospital, Boston, Massachusetts (T.G.).
¹² University of Washington, Seattle, Washington (C.T.L.).
¹³ Mbarara University of Science and Technology, Mbarara, Uganda; Harvard T.H. Chan School of Public Health, Boston, Massachusetts; and The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (S.O.).
¹⁴ Massachusetts General Hospital, Boston, Massachusetts; Mbarara University of Science and Technology, Mbarara, Uganda; and Kabwohe Clinical Research Center, Kabwohe, Sheema, Uganda (S.A.).

PMID: 40073231
PMCID: PMC12022967 (available on 2025-10-01)
DOI: 10.7326/ANNALS-24-02233

Epidemiology of Coronary Atherosclerosis Among People Living With HIV in Uganda : A Cross-Sectional Study

Mark J Siedner et al. Ann Intern Med. 2025 Apr.

. 2025 Apr;178(4):468-478.

doi: 10.7326/ANNALS-24-02233. Epub 2025 Mar 12.

Authors

Affiliations

¹ Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Mbarara University of Science and Technology, Mbarara, Uganda; Africa Health Research Institute, KwaZulu-Natal, South Africa; and University of KwaZulu-Natal, Durban, South Africa (M.J.S.).
² Massachusetts General Hospital, Boston; and Harvard Medical School, Boston, Massachusetts (B.G., M.T.L., S.S.H.).
³ Makerere University, Kampala; and Nsambya Hospital, Kampala, Uganda (G.E., R.N.).
⁴ Massachusetts General Hospital, Boston, Massachusetts (M.R., A.T., Z.R., R.F.G., E.P., S.S., Y.T.).
⁵ Nsambya Hospital, Kampala; and Mulago National Referral Hospital, Kampala, Uganda (A.O.).
⁶ Mbarara University of Science and Technology, Mbarara, Uganda (M.A., F.A., P.B.).
⁷ Yale University School of Medicine, New Haven, Connecticut (V.T.).
⁸ Kabwohe Clinical Research Center, Kabwohe, Sheema, Uganda (E.T.).
⁹ Department of Medicine, University of Cape Town, Cape Town; and the South African Medical Research Council, Cape Town, South Africa (N.A.B.N.).
¹⁰ Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Mbarara University of Science and Technology, Mbarara, Uganda; and Harvard T.H. Chan School of Public Health, Boston, Massachusetts (A.C.T.).
¹¹ Harvard Medical School, Boston; Harvard T.H. Chan School of Public Health, Boston; and Brigham and Women's Hospital, Boston, Massachusetts (T.G.).
¹² University of Washington, Seattle, Washington (C.T.L.).
¹³ Mbarara University of Science and Technology, Mbarara, Uganda; Harvard T.H. Chan School of Public Health, Boston, Massachusetts; and The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (S.O.).
¹⁴ Massachusetts General Hospital, Boston, Massachusetts; Mbarara University of Science and Technology, Mbarara, Uganda; and Kabwohe Clinical Research Center, Kabwohe, Sheema, Uganda (S.A.).

PMID: 40073231
PMCID: PMC12022967 (available on 2025-10-01)
DOI: 10.7326/ANNALS-24-02233

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.

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Conflict of interest statement

Disclosures: Disclosure forms are available with the article online.

References

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Epidemiology of Coronary Atherosclerosis Among People Living With HIV in Uganda : A Cross-Sectional Study

Affiliations

Epidemiology of Coronary Atherosclerosis Among People Living With HIV in Uganda : A Cross-Sectional Study

Authors

Affiliations

Abstract

Conflict of interest statement

References

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical