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Original research
Cardiovascular risk in an HIV-infected population in India
  1. Ivan P Marbaniang1,
  2. Dileep Kadam2,
  3. Rohan Suman2,
  4. Nikhil Gupte1,3,
  5. Sonali Salvi2,
  6. Sandesh Patil1,
  7. Dhananjay Shere1,
  8. Prasad Deshpande1,
  9. Vandana Kulkarni1,
  10. Andrea Deluca1,4,
  11. Amita Gupta1,3,
  12. Vidya Mave1,3
  1. 1 Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
  2. 2 Department of Medicine, Byramjee Jeejeebhoy Government Medical College, Pune, Maharashtra, India
  3. 3 Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  4. 4 Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
  1. Correspondence to Dr Ivan P Marbaniang, 1st Floor, Pathology Museum, 12 BJ Medical College Clinical Trials Unit, Jai Prakash Narayan Road, Pune, Maharashtra; ivanmarb{at}gmail.com

Abstract

Objective To characterise prevalence of traditional cardiovascular disease (CVD) risk factors, assess CVD risk and examine the effect of simulated interventions on CVD risk among HIV-infected Asian Indians.

Methods Cross-sectional data between September 2015 and July 2016 wer used to describe the prevalence of CVD risk factors. Five risk scores (Framingham, Data Collection on Adverse Effects of Anti-HIV Drugs Study (D:A:D), Atherosclerotic Cardiovascular, QRISK2 and Ramathibodi—Electricity Generating Authority of Thailand were used to estimate CVD risk. The effect of seven sensitivity analyses: smoking prevention; diabetes prevention; optimal blood pressure and dyslipidaemia control (total cholesterol, high-density lipoprotein (HDL)); CD4 augmentation and a combination of the scenarios on the median cumulative D:A:D CVD scores were assessed.

Results Of 402 enrolled, 56% were women, median age was 40 years (IQR: 35–45 years) and median time-updated CD4 counts were 378 cells/μL (IQR: 246–622). Fifty-five and 28% had ever been screened for hypertension and diabetes, respectively prior to enrolment. The prevalence of diabetes, hypertension, hypercholesterolaemia, low HDL, previous and current smokers were 9%, 22%, 20%, 39%, 14% and 4%, respectively. Thirty-six per cent had intermediate-to-high 5-year CVD risk by D:A:D estimates. Thirty-two per cent were eligible for statin therapy by American College of Cardiology/American Heart Association guidelines; 2% were currently on statins. In sensitivity analyses, diabetes prevention was associated with the highest reduction of CVD risk.

Conclusion CVD at younger ages among Asian Indian people living with HIV appear to be an imminent risk for morbidity. Stepping up of preventive services including screening services and prescription of statins are important strategies that must be considered.

  • HIV
  • cardiovascular diseases
  • India
  • Screening
  • diabetes mellitus
  • statins
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Footnotes

  • Contributors DK, NG, AD, AG, VM conceived the study idea. NG, VM, SP, AD framed the study design. IPM, SP, AD implemented study procedures. IPM conceived the idea for this particular manuscript; analysed and interpreted data and drafted the preliminary manuscript. RS, SS, SP provided clinical input to contextualise the study findings. DS, VK, PD helped in the acquisition and interpretation of laboratory data. All authors have critically evaluated the manuscript and provided intellectual inputs. All authors approve of the final revised version submitted for publication.

  • Funding Thiswork was supported by the American Foundation for AIDS Research from the USNational Institutes of Health, National Institute of Allergy and InfectiousDiseases, Eunice Kennedy Shriver National Institute of Child Health and HumanDevelopment, and National Cancer Institute as part of the International Epidemiologic Databases to Evaluate AIDS [U01AI069907] and the NationalInstitutes of Health funded Johns Hopkins Baltimore-Washington-India ClinicalTrials Unit for NIAID Networks [UM1AI069465]. The content of this paper issolely the responsibility of the authors and does not necessary represent theofficial views of the funders.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval BGJMC Ethics Committee and Johns Hopkins University Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The authors will make data available to the scientific community with as few restrictions as feasible, while retaining exclusive use until the primary research questions for which the study was devised have been answered and major outputs have been published. Following this, all available data can be obtained by contacting the corresponding author.

  • Correction notice This paper has been amended since it was published Online First. Owing to a scripting error, some of the publisher names in the references were replaced with 'BMJ Publishing Group'. This only affected the full text version, not the PDF. We have since corrected these errors and the correct publishers have been inserted into the references.

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