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HIV, cardiovascular disease, and stroke in sub-Saharan Africa

2016; Elsevier BV; Volume: 3; Issue: 8 Linguagem: Inglês

10.1016/s2352-3018(16)30092-3

2405-4704

Luchuo Engelbert Bain, Awah Paschal Kum, Nkoke Clovis Ekukwe, Nkeh Charles Clovis, Elvis Enowbeyang Tarkang,

Lipoproteins and Cardiovascular Health

Sub-Saharan Africa is facing a growing burden from non-communicable and infectious diseases including HIV infection. 1 Kengne AP June-Rose McHiza Z Amoah AGB Mbanya J-C Cardiovascular diseases and diabetes as economic and developmental challenges in Africa. Prog Cardiovasc Dis. 2013; 56: 302-313 Summary Full Text Full Text PDF PubMed Scopus (60) Google Scholar The therapeutic success permitting people living with HIV to live longer on combination antiretroviral therapy (ART) is being challenged by reported increases in adverse cardiovascular and metabolic disease profiles in these patients. 2 Escárcega RO Franco JJ Mani BC Vyas A Tedaldi EM Bove AA Cardiovascular disease in patients with chronic human immunodeficiency virus infection. Int J Cardiol. 2014; 175: 1-7 Summary Full Text Full Text PDF PubMed Scopus (23) Google Scholar , 3 Benjamin LA Corbett EL Connor MD et al. HIV, antiretroviral treatment, hypertension, and stroke in Malawian adults: a case-control study. Neurology. 2016; 86: 324-333 Crossref PubMed Scopus (101) Google Scholar , 4 Lang S Boccara F Mary-Krause M Cohen A Epidemiology of coronary heart disease in HIV-infected versus uninfected individuals in developed countries. Arch Cardiovasc Dis. 2015; 108: 206-215 Crossref PubMed Scopus (31) Google Scholar , 5 Lake JE Currier JS Metabolic disease in HIV infection. Lancet Infect Dis. 2013; 13: 964-975 Summary Full Text Full Text PDF PubMed Scopus (128) Google Scholar The growing burdens of cardiovascular diseases and stroke are already beyond the capacities of most health-care systems in Africa. 1 Kengne AP June-Rose McHiza Z Amoah AGB Mbanya J-C Cardiovascular diseases and diabetes as economic and developmental challenges in Africa. Prog Cardiovasc Dis. 2013; 56: 302-313 Summary Full Text Full Text PDF PubMed Scopus (60) Google Scholar , 6 Kengne AP Mayosi BM Readiness of the primary care system for non-communicable diseases in sub-Saharan Africa. Lancet Glob Health. 2014; 2: e247-e248 Summary Full Text Full Text PDF PubMed Scopus (34) Google Scholar 7–45% of patients with HIV have metabolic syndrome and coronary heart disease. 4 Lang S Boccara F Mary-Krause M Cohen A Epidemiology of coronary heart disease in HIV-infected versus uninfected individuals in developed countries. Arch Cardiovasc Dis. 2015; 108: 206-215 Crossref PubMed Scopus (31) Google Scholar , 5 Lake JE Currier JS Metabolic disease in HIV infection. Lancet Infect Dis. 2013; 13: 964-975 Summary Full Text Full Text PDF PubMed Scopus (128) Google Scholar , 7 Thakur KT Lyons JL Smith BR Shinohara RT Mateen FJ Stroke in HIV-infected African Americans: a retrospective cohort study. J Neurovirol. 2016; 22: 50-55 Crossref PubMed Scopus (14) Google Scholar HIV infection can result in stroke via several mechanisms, including opportunistic infection, vasculopathy, cardioembolism, and coagulopathy. 2 Escárcega RO Franco JJ Mani BC Vyas A Tedaldi EM Bove AA Cardiovascular disease in patients with chronic human immunodeficiency virus infection. Int J Cardiol. 2014; 175: 1-7 Summary Full Text Full Text PDF PubMed Scopus (23) Google Scholar , 4 Lang S Boccara F Mary-Krause M Cohen A Epidemiology of coronary heart disease in HIV-infected versus uninfected individuals in developed countries. Arch Cardiovasc Dis. 2015; 108: 206-215 Crossref PubMed Scopus (31) Google Scholar , 7 Thakur KT Lyons JL Smith BR Shinohara RT Mateen FJ Stroke in HIV-infected African Americans: a retrospective cohort study. J Neurovirol. 2016; 22: 50-55 Crossref PubMed Scopus (14) Google Scholar Benjamin and colleagues, 3 Benjamin LA Corbett EL Connor MD et al. HIV, antiretroviral treatment, hypertension, and stroke in Malawian adults: a case-control study. Neurology. 2016; 86: 324-333 Crossref PubMed Scopus (101) Google Scholar in a recent study in Malawi, have identified HIV as a significant risk factor for stroke, especially individuals aged 45 or younger. This double burden of disease in the context of limited resources calls for urgent attention in either reinforcing preventive measures that reduce the prevalence of stroke in these patients or measures to reduce HIV transmission. In people living with HIV, cardiovascular risk assessment is becoming an important element of care. 4 Lang S Boccara F Mary-Krause M Cohen A Epidemiology of coronary heart disease in HIV-infected versus uninfected individuals in developed countries. Arch Cardiovasc Dis. 2015; 108: 206-215 Crossref PubMed Scopus (31) Google Scholar