HIV, immune activation and cardiovascular disease in the sub-Saharan African context
HIV is a public health concern with currently 37 million people living with HIV (PLHIV) globally. Around 70% of PLHIV reside in sub-Saharan Africa (SSA). Antiretroviral therapy (ART) has turned HIV from a deadly disease into a chronic condition. HIV has been associated with a 2-fold increased risk of cardiovascular disease (CVD) in high-income countries. The aim of this thesis is to get insight into the role of HIV and ART on CVD risk in SSA, while considering the role of immune activation. In two systematic reviews no clear association between any marker of immune activation and CVD risk could be detected. Second, the frequency of CVD risk factors like hypertension and obesity was compared between PLHIV and HIV-negative people and PLHIV turned out to have fewer CVD risk factors then HIV-negatives. Third, the occurrence of subclinical CVD was assessed with surrogate markers. In one study, including almost 2000 participants at a rural site, PLHIV who are on ART had more subclinical CVD from the age of 30 years compared to HIV-negative people. This result could not be confirmed in another study including 550 participants as no association between HIV, ART and subclinical CVD was found. However, this study included less participants over the age of 50 years, and there was more viral suppression than in the rural study population. In conclusion, HIV is associated with less CVD risk factors but, despite this, with an increase in subclinical CVD in PLHIV on ART from the age of 30 years.