| dc.description.abstract | The introduction of effective combination antiretroviral therapy for HIV treatment has transformed HIV infection into a chronic infectious disease [1] as a result of decreased mortalities from AIDS and opportunistic infection. PLHIV are now living longer due to the efficacy of the current antiretroviral therapy regimens. Chronic cardiopulmonary diseases such as pulmonary hypertension and other non-communicable diseases are becoming a major public health problem among PLHIV[2] and contributing significantly to morbidity and mortalities. Advancing age among PLHIV due to the efficacy of available antiretroviral therapy regimens increases their risks of developing pulmonary hypertension[3] among PLHIV. HIV infection increases the risk of PHT by about 2500-fold compared to the HIV-negative population. PHT is associated with significant morbidity and mortality among PLHIV, reducing their survival by 50% {Bigna, 2019 #1}. Data on the prevalence and factors associated with PHT among PLHIV in Uganda is currently limited. Objective To determine the prevalence and factors associated with PHT among adults living with HIV attending Kiruddu Hospital HIV-clinicPatients and Methods. This was a cross-sectional study, conducted in Kiruddu Hospital, HIV-clinic. We enrolled 439 adult PLHIV using a systematic sampling method whereby we enrolled every 6th client who attended the HIV clinic on each day of enrollment till we attained the maximum sample size. A semi-structured questionnaire was administered to collect socio-demographic data, and HIV-specific, clinical, and laboratory data from the study participants. Standard trans-thoracic echocardiography was performed according to the American Society of Echocardiography guidelines(ASE) on all study participants and measurements of the RVSP and associated cardiac structures including Right atrial and right ventricular (RV) structure and tricuspid annular plane systolic excursion (TAPSE) were obtained. Data was analyzed using STATA version 17.0. Factors at bivariate analysis with p-value <0.2 were then introduced at the multivariate analysis to identify factors independently associated with PHT among the study participants. Results: In this study, we screened 481 eligible participants and enrolled 439. 296 of the study participants were female, and 52.4% of the participants were diagnosed with HIV infection for > 5 years. The median age of participants was 40 years (IQR 31-50 years). Of the 439 study participants enrolled, we diagnosed PHT in 81 participants. Therefore, the prevalence of PHT was determined to be 18.4%. Significant associated factors of PHT among our participants included detectable viral load with a prevalence ratio of 2.9(95% CI: 1.25-5.81), age >40 years with a prevalence ratio of 3.2 (95% CI: 1.86-5.46), prior TB diagnosis with a prevalence ratio of 1.2 (95% CI: 1.04-2.53), prior COVID-19 diagnosis with a prevalence ratio of 1.5(95% CI: 1.11-3.40), and occupational exposure to inhaled dust with a prevalence ratio of 1.5(95% CI: 1.04-2.51). 54.4% of the study participants reported symptoms suggestive of PHT, where 14.4%(n=63) of the study participants reported a history of easy fatigability, 9.3% (n-41) reported a history of dyspnea, 11.6% (n=51) reported lower limb swelling and 19.1% (n=84)reported chest pain as their chief symptoms.
However, there were no statistically significant associations between PHT and factors such as sex, duration of HIV diagnosis, or CD4 count and other comorbid conditions like sickle cell disease, kidney disease, and history of cardiovascular disease or liver disease among others. Conclusion: Our study concluded that approximately 1 in 5 PLHIV had PHT. Therefore, PLHIV with risk factors such as detectable viral load, previous TB diagnosis, and older age should be regularly assessed for PHT symptoms for early diagnosis and management. | en_US |
