cardiovascular disease risk factor profiles of hiv-infected clients: findings from a pilot program...
TRANSCRIPT
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PEPFAR
Cardiovascular Disease Risk Factor Profiles of HIV-infected Clients: Findings from a pilot program to integrate CVD screening into HIV services at a
secondary health facility in Kano, North-Western Nigeria.
1U.Gwarzo, 1T.Maji, 1S.Isa-Dutse, 1Y.Ahmed, 1K.Obayagbona, 2E. Okechukwu, 1S.Odafe, 1H.Khamofu, 1K.Torpey, 1O.Chabikuli
1FHI 360 Nigeria. 2USAID Nigeria
AIDS 2012 - Turning the Tide Together
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BACKGROUND
• Growing evidence from previous studies have shown an increased prevalence of CVD in HIV infected persons
• CVD in HIV infected persons arise from viral effects or antiretroviral medications (ART).
• CVD risk factors, such as Hypertension, hyperlipidaemia, Diabetes Mellitus and Lipodystrophy are seen in HIV infected client
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AIM
• To implement a pilot study in a secondary health facility that will assess the feasibility of integrating routine screening for cardiovascular risk factors in an HIV clinic setting, in order to inform programmatic approaches.
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Murtala Mohammed Specialist Hospital, Kano
• Located in the Northern Nigeria’s largest city, capital of the most populous state in Nigeria [ 2006 census]
• Established in 1922, >1000 bed capacity • Secondary health facility with about 100 doctors, > 800
nurses and hundreds of supporting staffs • An average of 7,000 General out-patients encounters
daily • Has 6,547 enrolled HIV clients with 3,671 on ART [March
2012]
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METHODOLOGY• Cross sectional study involving review of collected patient data• Male & female HIV infected clients enrolled for care between May
2010 - August 2011 were randomly selected for CVD screening using a developed CVD screening tool
• Those identified with specified CVD risk factors were referred for Laboratory evaluation of FBS & Lipid profile
• The 10 year CVD risk of developing a fatal or non-fatal cardiovascular event using the WHO/ISH AFR-D risk assessment charts was then determined for the clients
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METHODOLOGY
• Targeted behavioral & biomedical interventions which included referrals to an onsite cardiac clinic were provided for clients with CVD risk of > 20% including bi-annual check
• Follow-up CVD risk assessments were scheduled annually for clients with < 20% CVD risk
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Data analysis
• Data was cleaned, coded, entered into Statistical Package for the Social Sciences (SPSS), version 15 (SPSS Inc., Chicago IL).
• Statistical association was determined using Chi- square, One-Way ANOVA and Tuskey Honest Significant Difference
• Outcome variables include distribution of risk factor variables, duration on ART and the value (mean) of Cholesterol, HDL and LDL in both ART and ART naïve clients
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RESULTS• A total of 1,033 HIV-positive male and female clients were screened• Age Range: 17 – 70 years• A total of 205 clients (19.8%) had 1 or more risk factors, and sent for
laboratory evaluation• Most common modifiable risk factors identified were:
High BMI: 21.8%Hypertension: 15.2%
• Among those sent for laboratory evaluation:
42% had a CVD risk of < 20%
2.4% had a CVD risk of >/= 20%
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Demographic characteristics of the study population
Age-group (yrs)
NON ART RECEIVING ART
Female Male Total Female Male Total
< 25 28 (100%) 0 (0.0%) 28 84 (95.5%) 4 (4.5%) 88
25 - 29 39 (95.1%) 2 (4.9%) 41 180 (90%) 20 (10%) 200
30- 34 29 (78.4) 8 (21.6%) 37 146 (77.2%) 43 (22.8%) 189
35 - 39 20 (66.7%) 10 (33.3%) 30 96 (62.9%) 55 (37.1%) 151
40 - 44 10 (50%) 10 (50%) 20 66 (58.4%) 47 (41.6%) 113
45 - 49 5 (45.5%) 6 (54.5%) 11 23 (41.8%) 32 (58.2%) 55
>50 5 (50%) 5 (50%) 10 32 (55.2%) 26 (44.8%) 58
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Frequency distribution of CVD risk factors by ART status
Variables
Totaln (%)
On ARTn (%)
ART naïven (%)
P-value
SexFemale Male
765 (74.1)268 (25.9)
627 (82.2)227 (84.7)
136 (17.8)41 (15.3)
0.35
Age (years)< 40≥ 40
766 (74.3)265 (25.7)
625 (82.2)227 (84.7)
139 (18.2)38 (14.3)
0.15
BMI (kg/m2)<25≥ 25
751 (78.2)209 (21.8)
620 (82.6)177 (85.1)
131 (17.4)31 (14.9)
0.39
Blood pressure (mmHg)≤140/90>140/90
814 (84.8)146 (15.2)
666 (82.0)123 (84.3)
146 (18.0)23 (15.8)
0.52
SmokingYes No
82 (8.0)943 (92.0)
68 (82.9)780 (82.9)
14 (17.1)161 (17.1)
0.99
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Analysis of relationship between hyperlipidaemia and duration on treatment
Duration on ART N Mean F Significance
Total Cholesterol
< 1Yr 33 3.93
4.038 0.021-<3Yrs 52 4.49
>=3Yrs 67 4.54
Total 152 4.39
HDL < 1Yr 34 1.10
0.729 0.4841-<3Yrs 52 1.13
>=3Yrs 67 2.25
Total 153 1.61
LDL < 1Yr 33 2.88
0.472 0.6241-<3Yrs 52 3.36
>=3Yrs 67 2.29
Total 152 2.78
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RESULTS
• Although all risk factors were more prevalent in those receiving ART, there was no statistical difference with the ART-naïve group
• Mean serum total cholesterol levels were found to increase as duration on ART increased
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Discussion
• Developing countries are increasingly facing the double epidemics of CD and NCD, including CVD
• BMI of > 25 kg/m2 found to be 28.1% and BP > 140/90 mmHg found to be 15.2%
• The mean serum total cholesterol levels were observed to increase as the duration on ART increased
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CONCLUSION
• We conclude that integration of screening for cardiovascular diseases in ART clinic settings is feasible and essential, in order to improve the life expectancy of HIV-positive individuals.
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THANK
YOU