Thesis (Ph.D. (Physiology and Environmental Health)) -- University of Limpopo, 2021 / Background: Human immunodeficiency virus (HIV)-infection remains a major public
health burden where approximately 38 million people are affected globally. Human
immunodeficiency virus infection is associated with chronic inflammation which can
lead to endothelial dysfunction and thrombosis, which are precursor events for cardiometabolic
abnormalities such as dysglycaemia and dyslipidaemia. The degree of
chronic inflammation, endothelial dysfunction, and hypercoagulation among HIVpositive
adults on highly active antiretroviral therapy are not well understood in Sub-
Saharan Africa. The objective of this study was to determine the effect of highly active
antiretroviral therapy (HAART) on chronic inflammation, endothelial dysfunction, and
hypercoagulation among HAART-exposed adult South African participants in a rural
setting.
Aim: The study aimed to determine the effects of HAART on early biomarkers of
cardiovascular disease in the HIV-positive subjects.
Methods: The study was cross-sectional, descriptive, and quantitative in design. The
research population consisted of 158 participants of males and females within the age
range of 18 – 81 years from Mankweng Hospital and surrounding clinics. The study
population comprised of three groups, HIV-negative (control group), HIV-positive
treatment naïve (HAART-naïve group), and HIV-positive participants on HAART
(HAART-exposed group). Weight and height were measured using Omron BF 400 and
a portable stadiometer respectively, to calculate the body mass index. Glucose and
lipid levels were determined on Cobas® Integra 400 plus auto-analyser. The CD4+ T
cell count was determined on the Cytomics FC500 Flow Cytometer Multi-Platform
loader. The concentration of fibrinogen, c-reactive protein (CRP), L-selectin, D-dimers,
P-selectin, von Willebrand factor (VWF), soluble intercellular adhesion molecule
(sICAM-1), and soluble vascular cell adhesion molecule (sVCAM-1) in serum samples
were determined on the Luminex 200TM. Data were analysed using SPSS version
25.0. Descriptive statistics were performed on all variables and analysis of covariance
was used to determine differences across all groups. Correlation coefficients and
multiple regression analyses were used to determine associations.
Results: Body mass index (BMI) and glucose metabolism were not significantly
affected by HAART exposure. However, the HAART-exposed group had significantly
increased LDL-C (F (2, 154) = 7.501, p = 0.001) and TC (F (2, 154) = 9.174,
0.0002) levels. The prevalence of high LDL-C levels was significantly elevated in the
HAART-exposed group (29.6%) (p = 0.041). The prevalence of pre-diabetes (11.3%)
was the highest among the HAART-exposed group (non-significant), although, no
significant difference was observed. While P-selectin was significantly reduced in the
HAART-exposed group (F (2, 154 = 7.253, p = 0.001). On the other hand, the HAARTexposed
group also significantly increased VWF (F (2, 154 = 4.556, p = 0.011). The
HAART-exposed group showed no significant effect on L-selectin, sICAM-1, sVCAM-
1, CRP, fibrinogen and D-dimer levels. However, D-dimer was negatively associated
with HAART (r = -0.249, p = 0.011). There were significant independent association
between the combined HAART regimens and P-selectin (Std β = 0.219, p = 0.032),
first-line regimen with both P-selectin (Std β = 0.434, p = 0.004) and sVCAM-1 Std β
= 0.328, p = 0.031), second-line regimens with L-selectin (Std β = 1.032, p = 0.005)
and, a positive independent association between first-line regimen and D-dimer (β =
0.741, p = 0.0001). Although BMI and glucose metabolism were not significantly
affected in both the HAART-exposed and HAART-naïve groups, dyslipidaemia was
present across the three groups (HAART-exposed, HAART-naïve and control).
HAART-exposure showed a protective effect by reducing endothelial dysfunction (ED)
and hypercoagulation. Yet, ED was still present among this rural South African
HAART-exposed population. The HAART-exposed group may be at increased risk for
CVD. Therefore, CVD should be regularly monitored in the HAART-exposed
population. / National Research Fund, the Health and
Welfare Sector Education and Training Authority, and the University of Limpopo (UL)
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:ul/oai:ulspace.ul.ac.za:10386/3686 |
| Date | January 2021 |
| Creators | Hanser, Sidney |
| Contributors | Van Staden, M., Erasmus, L. J. C, Moraba, M. M. |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | xvii, 168 leaves |
| Relation |
Page generated in 0.0015 seconds