Effect of Antiretroviral Treatment (ART) on Cardiovascular Risk Factors among People Living with HIV in LMIC: A systematic review

Kasim Abdulai; Kwasi Torpey; Agnes M. Kotoh; Francis Adane; John Azaare; Amos Laar

Kasim Abdulai Translational Nutrition Research Group, Department of Clinical Nutrition and Dietetics, University of Cape Coast, Cape Coast, Ghana
Kwasi Torpey Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Accra, Ghana
Agnes M. Kotoh Department of Population, Family and Reproductive Health, School of Public Health, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
Francis Adane Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
John Azaare Department of Health Services Policy Planning and Economics, University for Development Studies, Tamale, Ghana
Amos Laar Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Accra, Ghana

Keywords: HIV, antiretroviral therapy, cardiovascular disease, risk factors, LMIC

Abstract

Background: Effective use of antiretroviral treatment (ART) is known to reduce HIV/AIDS-related morbidity and mortality significantly. However, as life expectancy increases, the risk factors for cardiovascular disease become more prevalent. Data on the risk of cardiovascular diseases in relation to antiretroviral therapy in low- and middle-income countries (LMIC) remain limited.
Objective: In this review, we examined the association between antiretroviral therapy and cardiovascular disease (CVD) risk factors (hypertension, diabetes, dyslipidaemia) among people living with HIV (PLHIV) in LMIC.
Methods: We conducted a systematic review and meta-analysis of studies on LMIC published between 2007 and 2018. Studies published in English and indexed in PubMed, Scopus, Cochrane, and Google Scholar were critically reviewed, and the effect of estimates were pooled for hypertension, diabetes, and high lipid profiles using a random-effects meta-analysis. In all, twenty-one studies were included involving 12,229 participants after screening.
Results: There was no link found between ART use and diabetes (RR = 0.88, 95% CI: 0.58 - 1.33). ART use was, however, associated with hypertension (RR = 1.74, 95% CI: 1.21 - 2.50), increased total cholesterol (RR = 2.72, 95% CI: 1.75 - 4.23), high triglycerides concentration (RR = 1.64, 95% CI: 1.50 - 1.80), elevated LDL-cholesterol (RR = 2.72, 95% CI: 1.75 - 4.23)., and decreased HDL-cholesterol (RR=0.65, 95% CI: 0.58 - 0.77).
Conclusion: There is an association between antiretroviral therapy and raised LDL, triglycerides, total cholesterol, and hypertension in LMIC, hence the need to provide tailored education on CVD risk factors among PLHIV. Moreover, there is a need to formulate policies and programmes aimed at addressing CVDs among PLHIV in LMIC.