Elevated N-terminal prohormone of brain natriuretic peptide among persons living with HIV in a South African peri-urban township.

Abstract

AIMS:

Efforts to improve access to antiretroviral therapy (ART) have shifted morbidity and mortality among persons living with HIV (PLWH) from AIDS to non-communicable diseases, such as cardiovascular disease (CVD). However, contemporary data on CVD among PLWH in sub-Saharan Africa in the current ART era are lacking. The aim of this study was to assess the burden of cardiac stress among PLWH in South Africa via measurement of N-terminal prohormone of brain natriuretic peptide (NT-proBNP).

METHODS AND RESULTS:

NT-proBNP was measured at baseline in 224 PLWH enrolled in a sub-study of a tuberculosis vaccine trial in Khayelitsha township near Cape Town, South Africa. Thresholds were applied at the assay's limit of detection (≥137 pg/mL) and a level indicative of symptomatic heart failure in the acute setting (>300 pg/mL). Mean (SD) age of participants was 39 (6) years, 86% were female, and 19% were hypertensive. Mean (SD) duration of HIV diagnosis was 8.3 (3.9) years and CD4 + count was 673 (267) with 79% prescribed ART for a duration of 5.6 (2.7) years. Thirty-one percent of participants had NT-proBNP > 300 pg/mL. Elevated vs. undetectable NT-proBNP level was associated with older age (P = 0.04), no ART (P = 0.03), and higher plasma tumour necrosis factor-α (P = 0.01).

CONCLUSIONS:

Among South African PLWH largely free of known CVD and on ART with high CD4 + counts and few comorbidities, we observed a high proportion with elevated NT-proBNP levels, suggesting the burden of cardiac stress in this population may be high. This observation underscores the need for more in-depth research, including the current effect of HIV on heart failure risk among a growing ART-treated population in sub-Saharan Africa.

• Authors: Tess E Peterson, Jason V Baker, Lye-Yeng Wong, Adam Rupert, Ntobeko A B Ntusi, Hanif Esmail, Robert Wilkinson, Irini Sereti, Graeme Meintjes, Mpiko Ntsekhe, Friedrich Thienemann
• Journal: ESC heart failure (ESC Heart Fail) Vol. 7 Issue 5 Pg. 3246-3251 (10 2020) ISSN: 2055-5822 [Electronic] England
• PMID: 32585776 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.

Chemical References

• Anti-Retroviral Agents
• Peptide Fragments
• Natriuretic Peptide, Brain

Topics

• Adult
• Aged
• Anti-Retroviral Agents
• Cardiovascular Diseases
• Female
• HIV Infections (complications, drug therapy, epidemiology)
• Humans
• Male
• Natriuretic Peptide, Brain
• Peptide Fragments
• South Africa (epidemiology)