Serum Biomarkers For Risk Of Cardiovascular Disease In Patients On Highly Active Antiretroviral Therapy In Homa-Bay County Referral Hospital, Kenya

Abstract

Background: Human Immunodeficiency Virus (HIV) continues as a major public health problem both in developing as well as developed nations. The prevalence of HIV in Kenya as determined by the National Aids Control Council in 2015 stands at six percent. However, regional variation exists with Homa-Bay County ranking highest at 25.7 percent. With the introduction of highly active antiretroviral therapy (HAART), a decline in morbidity and mortality from HIV has been observed. Recent studies have showed that a strong association exists between dysregulated concentrations of serum lipids and sugar, which are recognised markers of cardiovascular disease, and HAART use. However, it remains unclear if the findings of these studies would be observed at the Home-Bay County Referral Hospital. Thus, this study intended to correlate the serum concentrations of these markers with the duration of HAART use. Research Question: Does prolonged use of HAART raise the levels of serum biomarkers for risk of CVD among HIV-positive individuals receiving care in Homa Bay County referral hospital? Objective: To determine the correlation between levels of serum biomarkers for risk of CVD with the duration of HAART use among HIV-positive individuals receiving care in Homa Bay County referral hospital. Specific Objectives:  To determine serum concentration of HbA1C, TC, LDL-C, HDL-C and MPO in individuals using HAART.  To calculate the proportion of the participants at low and high risk based on the the levels of their serum HbA1C, TC, LDL-C, HDL-C and MPO. 14  To determine the correlation between HAART duration and increased levels of the biomarkers for risk of CVD. Study Design: This was a descriptive cross-sectional study Study Area: Participants recruitment and data collection was done in the Comprehensive Care Clinic at the Homa-Bay County Referral Hospital. The biochemical analysis was done at the Kenyatta National Hospital. Study Population: Study population consisted of HIV-positive males and females of ages between 18 and 45 years, who had been on HAART for at least six months. The sample size was 120. Methodology: Systematic random sampling technique was used to collect blood samples from participants after they gave consent to participate in the study. Four (4) ml non-fasting blood samples was collected aseptically from the antecubital vein and was then processed for biochemical analysis of Total-Cholesterol (TC), Low Density Lipoprotein- Cholesterol (LDL-C), High Density Lipoprotein-Cholesterol (HDL-C), Glycated Haemoglobin A1c (HbA1c), Lipoprotein-associated Phospholipase 2 (Lp-PLA2) and Myeloperoxidase (MPO). At the same time, demographic data and medical history of the participants were collected by use of a study questionnaire. Data entry was done in an excel spreadsheet. Descriptive statistics (mean, median and standard deviation) were used to analyse continuous variables. Chisquare test was used to test for the significance association between age and gender with HAART duration. Logistic regression was then used to test for the independent association between raised levels of the biomarkers with gender, age and HAART duration. Results: Majority of the participants (77%) were married and 64.2% had attained primary education. Most of the subjects (65%) were in self-employment. Majority of the participants 15 (67.5%) had been on HAART for more than sixty months. Most of the study participants had TC, LDL-C, HDL-C, HbA1c, Lp-PLA2 and MPO levels within the reference interval. The proportions with elevated levels above the reference interval were as follows; 14.2% (TC), 5.8% (LDL-C), 2.5% (HDL-C), 4.2% (HbA1c), 24.2% (Lp-PLA2) and 44.9% (MPO). Using logistic regression analysis, no significance correlation between gender and raised laboratory parameters was found. The same was reported for the different age categories except for 39 - <45 years, which had significantly increased TC level; OR = 1.57 (CI: 0.14 – 17.29, p = 0.021). Raised levels of biomarkers were not significantly correlated to HAART duration except for TC and Lp-PLA2 for HAART duration >60 months (OR = 1.62, CI: 0.28 – 9.43, p = 0.045 and OR = 1.65, CI: 0.43 – 6.39, p = 0.047 respectively). Conclusion: Majority of the participants who had at least one derangement in the laboratory parameters being abnormal had been on HAART for more than sixty months. Dysregulated concentrations of the serum biomarkers were not significantly associated to gender. Age was significantly associated to HAART duration. Serum concentrations of TC and Lp-PLA2 showed significant association between raised serum levels with the duration of HAART.