Prevalence of Cardiometabolic Disease Risk Factors in People living with HIV Initiating Anti-retroviral Therapy at a High-Volume HIV Clinic in Kampala, Uganda

Abstract

ABSTRACTBackgroundCardiometabolic diseases are a leading cause of HIV-related morbidity and mortality, yet routine screening is not undertaken in high burden countries. We aimed to assess the prevalence and risk factors of the metabolic syndrome (MetS) and its components in adult Ugandan people living with HIV (PLHIV) initiating dolutegravir-based antiretroviral therapy (ART).MethodsWe analyzed baseline data of PLHIV aged ≥ 18 years enrolled in the GLUMED (Glucose metabolism changes in Ugandan HIV patients on Dolutegravir) Study from January to October 2021. MetS was defined as having 3 or more of the following: abdominal obesity, hypertension (HTN), elevated fasting glucose, elevated triglycerides and low high-density lipoprotein cholesterol. Multiple logistic regression was used to assess associations between potential risk factors and MetS and its components.Results309 PLHIV were analyzed (100% ART-naive, 59.2% female, median age 31 years and median CD4 count 318 cells/mm3). The prevalence of MetS was 13.9%. The most common cardiometabolic condition was dyslipidemia (93.6%), followed by abdominal obesity (34.0%), hyperglycemia (18.4%), and HTN (8.1%). In adjusted analysis, MetS was associated with age > 40 years (odds ratio 3.33, 95% confidence interval 1.45-7.67) and CD4 count > 200 cells/mm3(3.79, 1.23-11.63). HTN was associated with age > 40 years (2.96, 1.32-6.64), and dyslipidemia was associated with urban residence (4.99, 1.35-18.53).ConclusionCardiometabolic risk factors were common in this young Ugandan cohort of PLHIV initiating dolutegravir-based ART, underscoring the need for programmatic implementation of surveillance and management of comorbidities in Uganda and similar settings.Key pointsIn Ugandan HIV patients initiating antiretroviral treatment, the prevalence of cardiometabolic risk factors was substantial: metabolic syndrome 13.9%, dyslipidemia 93.6%, abdominal obesity 34.0%, hyperglycemia 18.4%, and hypertension 8.1%. This highlights the need for early screening and management of comorbidities.