HIV and ART status at baseline are associated longitudinally with increased pulse wave velocity: findings from the Ndlovu Cohort Study.

OBJECTIVES

People with HIV (PWH) have an increased risk of cardiovascular disease (CVD), but longitudinal data from middle-income settings remain limited. This study examined the association between HIV, antiretroviral therapy (ART), and pulse wave velocity (PWV), a marker of arterial stiffness and CVD risk.

DESIGN

A longitudinal analysis from the Ndlovu Cohort Study, South Africa.

METHODS

The study included 705 participants (325 PWH, 81% on ART at baseline, 19% initiating ART at baseline, and 380 HIV-negative people. Demographic data, HIV/ART status, and covariates were collected at baseline, while PWV was measured at 12 and 36  months. Mixed-effects models were used to analyze PWV changes over time, adjusting for age, sex, and systolic blood pressure (SBP). Results were reported as beta coefficients ( β ) with 95% confidence intervals (CIs).

RESULTS

At baseline, PWH were older and predominantly female (67%) compared to HIV-negative people. At 12  months, median PWV was higher in PWH (7.3  m/s) than in HIV-negative people (7.0  m/s, P = 0.001). Over 36  months, PWV increased by 0.30  m/s in PWH and 0.20 m/s in HIV-negative people ( P  = 0.002). ART-naïve individuals had the largest PWV increase after starting ART (6.8  m/s at 12  months to 7.4  m/s at 36  months, P  = 0.001). HIV ( β = 0.65, 95% CI: 0.24-1.06, P  = 0.002) and time ( β = 0.31 m/s per year, P  < 0.001) were significantly associated with higher PWV.

CONCLUSIONS

PWV increased over time, particularly in PWH, with ART initiation linked to rapid increases. These findings highlight the need for early CVD risk monitoring, especially post-ART initiation, in resource-limited settings.