Lipid Profiles, Cardiovascular Disease Risk and Dyslipidemia in HIV-Positive Patients on HAART at Machakos Level Five Hospital, Machakos County, Kenya
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Date
2023-10
Authors
Syengo, Sarah Malinda
Journal Title
Journal ISSN
Volume Title
Publisher
Kenyatta University
Abstract
Human Immunodeficiency Virus infection is a worldwide pandemic that has been controlled and managed through the use of highly active antiretroviral therapy drugs. However, long-term use of antiretrovirals is linked with dyslipidemia and cardiovascular disease, which are major issues for public health. In developing countries such as Kenya, there is a gap in knowledge regarding the prevalence of dyslipidemia and risk of cardiovascular disease among persons on antiretroviral medication who have the Human Immunodeficiency Virus. Thus, this study determined the lipid profiles, the prevalence of dyslipidemia, the likelihood of acquiring cardiovascular disease, and the risk factors associated with dyslipidemia and cardiovascular disease in people who are positive for the Human Immunodeficiency Virus on antiretrovirals. The research was undertaken at Machakos Level V Hospital, Machakos County, Kenya for four months. The study applied a cross-sectional design. Systematic sampling was used to choose 406 study participants living with the Human Immunodeficiency Virus on antiretrovirals. Blood samples were obtained from each participant, and the serum obtained was used for the lipid profile test. The results were then used to determine the prevalence of dyslipidemia for the study participants. The study also applied the Framingham Risk Score in assessing cardiovascular disease risk in the next ten years. The Framingham Risk Score was based on seven coronary risk aspects: high-density lipoprotein, total cholesterol, age, sex, systolic blood pressure, time on antiretrovirals, and cigarette smoking. The risk factors were collected through structured questionnaires. Data on the lipid profiles, Framingham risk score, and prevalence of dyslipidemia and cardiovascular risk alongside assessed risk factors were presented using tables. A bivariable analysis was conducted to identify significant exposure variables linked to dyslipidemia and cardiovascular disease. Multivariate analysis was conducted, including exposure variables with p = ≤ 0.2. The findings showed that the total cholesterol to high-density lipoprotein cholesterol ratio was significantly linked with antiretroviral regimens p<0.05. Those using protease inhibitors were 4 times more expected to have a high ratio than those using non-nucleoside reverse transcriptase inhibitors (OR = 4.19), 95%CI: 1.03 - 17.02, p<0.05. Based on the Framingham Risk Score, 289(71.2%) had low cardiovascular disease risk, 75(18.5%) had moderate risk, 40(9.8%) had moderately high risk while 2(0.5%) had high risk. The results established that age, low high-density lipoprotein, cigarette smoking, and high systolic pressure were significantly linked with a high Framingham Risk Score (p<0.001). Gender and duration on Highly Active Antiretroviral Therapy were also significantly linked with a high Framingham Risk Score (p= 0.001). High total cholesterol values were not significantly linked with a high Framingham Risk Score (p= 0.313). The general occurrence of dyslipidemia in the study was 74.1%, with 301 participants having dyslipidemia. The findings showed that age was significantly linked with dyslipidemia (p = 0.005). High systolic pressure was significantly linked with dyslipidemia (p =0.049). Hypertension was significantly linked with dyslipidemia (p<0.001). Gender, age, high systolic pressure, history of hypertension, cigarette smoking, and cardiovascular disease family history were significantly linked with the risk of developing cardiovascular disease (p = <0.001). Diastolic pressure was not statistically significant (p = 0.861). People living with the Human Immunodeficiency Virus on antiretrovirals are still at a high risk of developing dyslipidemia and cardiovascular disease. The study offered information that will inform the policymakers on better approaches to employ in addressing the health outcomes for people living with the Human Immunodeficiency Virus under treatment with antiretrovirals while addressing the cardiovascular diseases that may be confounding by the use of antiretrovirals.
Description
A Thesis Submitted in Partial Fulfilment for the Requirements for the Award of Degree of Masters of Science in Medical Laboratory Science (Clinical Chemistry Option) in the School of Health Sciences of Kenyatta University, October 2023.
Keywords
Lipid Profiles, Cardiovascular Disease Risk, Dyslipidemia, HIV-Positive Patients, HAART, Machakos Level Five Hospital, Machakos County, Kenya