Evaluation of Vascular Event Risk while on Long-term Antiretroviral Suppressive Treatment (EVERLAST)

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SUMMARY/ABSTRACT Two out of three individuals living with HIV/AIDS worldwide reside in sub-Saharan Africa (SSA). Fortunately, due to a massive roll-out of potent combination Antiretroviral Therapy (cART), global rates of morbidity and mortality from HIV infection have declined significantly over the past decade. However, while the initiation of cART has led to a global decline in deaths from AIDS related opportunistic infections and malignancies, there has correspondingly been a surge in deaths from cardiovascular disease (CVD) and non- AIDS related cancers. In North American cohorts up to 10% of all deaths among people with HIV/AIDS have been attributed to CVD. The greater frequency of CVD complications among HIV patients is thought to be possibly due to HIV-stimulated endothelial activation, vasculopathies, opportunistic infections, neoplasia, prothrombosis, and metabolic derangements or cART directly causing immune activation and metabolic dysfunction that can accelerate systemic atherosclerosis. There is a striking paucity of data on the nature and contributors to CVD among HIV patients in SSA. Beyond the potential contributions of the virus or cART to CVD risk in HIV patients, enhancements in the socio-economic status of general populations in SSA has led to an increasing adoption of Western diets and lifestyles resulting in a growing epidemic of key CVD risk factors such as hypertension, diabetes mellitus and dyslipidemia. Information on the prevalence and predictors of co-existing CVD among HIV patients in SSA could permit the development of unique strategies to reduce CVD burden in these patients encountered in resource-limited settings. Currently, HIV patients cared for in SSA are not routinely or systematically screened/treated for CVD because of socioeconomic obstacles, cultural barriers, under- diagnosis, and a dearth of scientific information to guide providers. The overall objective of the Evaluation of Vascular Event Risk while on Long-term Anti-retroviral Suppressive Therapy (EVERLAST) study is to characterize the presence of CVD risk among 240 HIV subjects on cART in SSA (vs. 240 cART-naïve HIV patients and 240 HIV-uninfected subjects) and explore factors influencing it, while building sustainable capacity for a future intervention study across the lifespan in a resource-limited setting (Ghana). In EVERLAST, we will 1) assess the prevalence of CVD risk among HIV patients on cART for >1 year as defined by carotid intima media thickness, along with socio-econo-demographic factors, traditional CVD medical and lifestyle risk factors, HIV- related factors, and serologic indices; 2) we will obtain information and guidance about the barriers and facilitators influencing CVD risk management among HIV patients in SSA at the various levels of a social ecological model; and 3) based on data gathered from the earlier phases of the study, we will propose interventions at levels of the social ecological model to improve optimal CVD risk management of HIV patients on cART in SSA that can be tested in a future study.