Premature “asymptomatic” peripheral artery disease and correlates among HIV-positive adults in Ghana: findings from the SCRIPT study

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BACKGROUND: Peripheral artery disease represents a significant but yet under-recognized cardiovascular manifestation in people living with HIV. Despite the known increased global risk for PAD in people living with HIV, the burden of PAD remains unexplored in Ghana. The study assessed the prevalence and associated risk factors for PAD among HIV-positive persons in Ghana. METHODS: The study utilized a cross-sectional comparative design, recruiting consecutive HIV-positive adults from the HIV clinic of the Komfo Anokye Teaching Hospital and HIV-negative adults from surrounding communities in Ghana between August 2018 and December 2019. Participants were stratified into three groups: HIV-positive on antiretroviral therapy (HIV + ART+), HIV-positive not on therapy (HIV + ART−), and HIV-negative community controls (HIV − ART−). PAD was defined as an ankle-brachial index (ABI) ≤ 0.9 in either limb, measured using the BoSo ABI device. Multivariable logistic regression models identified independent predictors of PAD among HIV-positive participants using R (version 4.4.1) statistical software. RESULTS: The study included 434 participants: 156 HIV-positive individuals on antiretroviral therapy, 131 HIV-positive individuals not on therapy, and 147 HIV-negative controls. Mean ages were 48.0 years, 41.0 years, and 45.0 years, respectively. Peripheral artery disease prevalence was 50.7% (95% confidence interval: 41.7–59.0) among HIV-positive individuals on therapy, 32.9% (95% confidence interval: 22.7–45.4) among those not on therapy, and 46.7% (95% confidence interval: 37.0-56.6) among controls. Waist circumference and BMI were significantly associated with PAD among Controls compared with HIV-positive individuals (p-value < 0.01). Among HIV-positive participants, antiretroviral therapy use (adjusted odds ratio 2.6, 95% confidence interval: 1.3-5), elevated triglyceride levels (adjusted odds ratio 2.3, 95% confidence interval: 1.2–4.5), and family history of cardiovascular disease (adjusted odds ratio 2.8, 95% confidence interval: 1.2–6.2) were independently associated with peripheral artery disease. CONCLUSIONS: The study observed a high burden of PAD in a relatively young Ghanaian population with HIV, which was associated with ART use, higher triglyceride levels, and a family history of CVD. These findings emphasize the critical need for integrating routine PAD screening and cardiovascular risk assessment into HIV care programs to enable early detection and intervention, particularly given the asymptomatic nature of PAD in this population and the potential to prevent progression to symptomatic disease and major adverse cardiovascular events.

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