The present study sought to explore the functional changes that occur in the vasculature of HIV positive participants of African origin in Mthatha district of South africa which might lead to increased risk in their cardiovascular system. Available literature shows that arterial stiffness plays an important role in cardiovascular events such as stroke, vasculitis and myocardial infarction. Measurement of (aortic pulse wave velocity; PWV) provides some of the strongest evidence concerning the prognostic significance of large artery stiffening. This study was aimed at investigating the relationship between anthropometry, age, E-Selectin level, cytokine levels, haemodynamic variables, blood counts and blood lipid profile with pulse wave velocity. Some traditional cardiovascular risk factors such as alcohol, and smoking were also taken into account. This was a cross-sectional study comprising of 169 participants (62 males and 107 females). 63 were HIV negative (group A), 54 HIV positive on treatment (group B), and 52 were HIV positive not on treatment (group C). Pulse wave velocity (PWV) was assessed using the Sphygmocor Vx. Statistically, ANOVA was used for variables with normal distribution and non parametric tests were used for variables with skewed distribution. Notable significant differences were seen in the means of the following variables across all the 3 groups. The mean PWV value for group C (7.21±2.17) was greater than that for group B (6.84± 1.17) which in turn was more than group A (6.38±1.67); P=0.037. In participants who are HIV negative, In univariate analysis PWV correlated significantly with the following: Augmentation index; AIx (75): (r=0.850,p=0.004): Systolic aortic blood pressure; Spa: (r=0.635, p<.000); diastolic blood pressure; dbp: (r=0.436, p<0.000); aortic pulse pressure; Ppa: (r=0.472, p=0.000); Mean arterial pressure; MP: (r=0.446 p=<0.00) and age (r=0.606, p<0.000). In participants who are on HAART the following variables were positively correlated with PWV: Ppa: (r=0.338,p=0.012), MP: (r=0.400,p=0.400), monocytes (r=0.320,p=0.047). Neutrophils: (r=0.341,p=0.034), CD4: (r=-0.446,p=0.009). In participants who are HAART naïve and HIV positive the following correlated with PWV Spa: (r=0.369, p=0.012), MP: (r=0.400, r=0.003) Ppa: (r=0.338,p=0.012), waist to hip ratio: (r=0.319, p=0.037), platelets: (r=0.037, p=0.019), triglycerides: (r=0.490, p=0.002). With multiple linear regression Spa, age and triglycerides as the only independent and significant determinants of PWV among HIV negatives R2= 56.9% (adjusted R2=54.7%), model adjusted for gender, anthropometric parameters, HDL-C, TC, LDL-C, haematologic data, haemodynamic data, cytokines, smoking and alcohol. Only MP and waist circumference were identified as the most important and significant independent determinants of PWV in HIV positive participants not on treatment. Age, MP, HDL-C, and triglycerides were identified as the significant independent determinants of the variations of PWV in HIV positive participants on HAART. R2 =57 %(adjusted R2 =53.5%). Model adjusted for gender, anthropometric data, smoking, alcohol, cytokines, adhesion molecules, total cholesterol, LDL-C. Haematological data, CD4 count, and other haemodynamic parameters. For Aix(75) In HIV negatives the multiple linear regression model identified age (positive correlation), height (negative correlation), CD4 (positive correlation) and MP (positive correlation) as the independent and significant determinants of AIx (75) among HIV negatives. Spa and Age were independently and significantly associated with the variations of Aix(75) among HIV positives not on HAART. On the other hand height was negatively and significantly associated with Aix(75) amongst HIV positives not on HAART. After excluding confounding factors, height (negative correlation) age (positive correlation), MP (positive correlation, HDL-C (negative correlation), platelets (positive correlation) alcohol intake (excessive consummation associated with positive correlation) and TNFα (negative correlation) were identified as the independent and significant variables associated with increase in AIx(75) among HIV positive participants on HAART. Conclusion: This study showed that HIV infected patients with or without antiretroviral therapy have increase arterial stiffness which is associated with an increased cardiovascular risk. The sphygmocor is an accurate, non invassive and useful tool in the evaluation of arterial stiffness and its use in clinical practice should be encouraged. PWV and the augmentation index (AIx) are the two major non-invasive methods of assessing arterial stiffness. Life style modification should be incorporated into the management of HIV patients so as the continuous monitoring of their haematological and lipid profile.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wsu/vital:18483 |
| Date | January 2013 |
| Creators | Awotedu, Kofoworola Olajire |
| Publisher | Walter Sisulu University, Faculty of Health Sciences |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis, Doctoral, Ph D |
| Format | xlii, 359 leaves, pdf |
| Rights | Walter Sisulu University |
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