Cardiovascular risk factors in a treatment-naïve, human immunodeficiency virus-infected rural population in Dikgale, South Africa

Objective: The objective was to determine lipid levels and cardiovascular risk factors in treatment-naïve, humanimmunodeficiency virus (HIV)-infected rural African people in Limpopo province.Design: This was a case control study.Setting and subjects: The setting was Dikgale Health and Demographic Surveillance System Centre, Limpopo province. Treatment naïve, HIV-infected and HIV-negative people participated in the study.Outcome measures: Demographic, lifestyle and chronic disease data were collected using the World Health Organization stepwise approach to surveillance (STEPS) questionnaire. Biochemical parameters were tested using standard biochemical methods. HIV testing and CD4 counts were performed using the Alere Determine™ HIV 1/2 Ag/Ab kit and The Alere Pima™ Analyser. Insulin resistance, low-density lipoprotein cholesterol (LDL cholesterol), and non-high-density lipoprotein cholesterol (non-HDL cholesterol) levels were calculated.Results: The mean age of participants (years) was 49.7 ± 16.6. More HIV-infected than HIV-uninfected women consumed alcohol (25.4% vs. 11.9%, p-value < 0.05), and the prevalence of abdominal obesity was higher in HIV-uninfected than in HIV-infected women (74.6% vs. 54.8%, p-value < 0.05). Levels of total cholesterol (TC), HDL cholesterol, non-HDL cholesterol, LDL cholesterol and apolipoprotein A1 (ApoA1) were significantly lower in the HIV-infected than in the HIV-uninfected group. The prevalence of low HDL cholesterol was higher in HIV-infected than in HIV-uninfected people (62.4% vs. 41.6%, p-value < 0.01). HIV infection increased the likelihood of low HDL cholesterol by 2.7 times (p-value 0.001). Male gender and alcohol use decreased the likelihood of low HDL cholesterol by 61% (p-value 0.002) and 48% (p-value 0.048), respectively. HIV infection was associated with low HDL cholesterol, ApoA1, LDL cholesterol and TC. Low CD4 count was associated with low body mass index, LDL cholesterol and high diastolic blood pressure.Conclusion: The prevalence of cardiovascular risk factors was equally high in HIV-infected and in HIV-uninfected rural people, except for low HDL and alcohol consumption, which were significantly higher in HIV-infected people, while abdominal obesity was significantly higher in HIV-uninfected people. There is a need to raise awareness of cardiovascular risk factors in rural people in Limpopo province.Keywords: abdominal obesity, alcohol, diabetes, hypertension, lipid

Genetic-substructure and complex demographic history of South African Bantu speakers

South Eastern Bantu-speaking (SEB) groups constitute more than 80% of the population in South Africa. Despite clear linguistic and geographic diversity, the genetic differences between these groups have not been systematically investigated. Based on genome-wide data of over 5000 individuals, representing eight major SEB groups, we provide strong evidence for fine-scale population structure that broadly aligns with geographic distribution and is also congruent with linguistic phylogeny (separation of Nguni, Sotho-Tswana and Tsonga speakers). Although differential Khoe-San admixture plays a key role, the structure persists after Khoe-San ancestry-masking. The timing of admixture, levels of sex-biased gene flow and population size dynamics also highlight differences in the demographic histories of individual groups. The comparisons with five Iron Age farmer genomes further support genetic continuity over ∼400 years in certain regions of the country. Simulated trait genome-wide association studies further show that the observed population structure could have major implications for biomedical genomics research in South Africa

Prevalence of metabolic syndrome among HIV-positive and HIV-negative populations in sub-Saharan Africa-a systematic review and meta-analysis

BACKGROUND: Metabolic syndrome (MetS) is a constellation of conditions that increase the risk of cardiovascular diseases. It is an emerging concern in sub-Saharan African (SSA) countries, particularly because of an increasingly aging population and lifestyle changes. There is an increased risk of MetS and its components among people living with Human immune deficiency syndrome (HIV) individuals; however, the prevalence of metabolic syndrome in the SSA population and its differential contribution by HIV status is not yet established. This systematic review and meta-analysis were conducted to estimate the pooled prevalence of metabolic syndrome in people living with HIV and uninfected populations, its variation by sub-components. METHODS: We performed a comprehensive search on major databases-MEDLINE (PubMed), EBSCOhost, and Cochrane Database of Systematic Reviews and Web of sciences for original epidemiological research articles that compared proportions of the MetS and its subcomponents between people living with HIV and uninfected patients and published between January 1990-December 2017. The inclusion criteria were adults aged ≥ 18 years, with confirmed HIV status. We assessed the risk of bias using a prevalence studies tool, and random effect meta-analyses were used to compute the pooled overall prevalence. RESULTS: A total of four cross-sectional studies comprising 496 HIV uninfected and 731 infected participants were included in the meta-analysis. The overall prevalence of MetS among people living with HIV was 21.5% (95% CI 15.09-26.86) versus uninfected 12.0% (95% CI 5.00-21.00%), with substantial heterogeneity. The reported relative risk estimate for MetS among the two groups was twofold (RR 1.83, 95% CI 0.98-3.41), with an estimated predictive interval of 0.15 to 22.43 and P = 0.055 higher for the infected population. Hypertension was the most prevalent MetS sub-components, with diverse proportions of people living with HIV (5.2-50.0%) and uninfected (10.0-59.0%) populations. CONCLUSIONS: The high range of MetS prevalence in the HIV-infected population compared to the uninfected population highlights the possible presence of HIV related drivers of MetS. Also, the reported high rate of MetS, irrespective of HIV status, indicates a major metabolic disorder epidemic that requires urgent prevention and management programs in SSA. Similarly, in the era of universal test and treat strategy among people living with HIV cohorts, routine check-up of MetS sub-components is required in HIV management as biomarkers. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42016045727

Haematological disorders in HIV-infected people in a semi-rural area in the Capricorn district of Limpopo province, South Africa

Infection with human immunodeficiency virus (HIV) is a global epidemic with about 37 million people infected worldwide. Infection prevalence in South Africa is approximately 17% of the total global cases, with high mobility and mortality rates. Despite the high statistics of HIV infection in South Africa, little is known regarding the burden of haematological disorders in people infected with HIV. The purpose of the study was, therefore, to determine and describe haematological disorders in HIV-infected people on antiretroviral treatment (ART) and those not on ART, in the semi-rural villages of Ga-Mothapo in the Limpopo Province, South Africa. The study was cross-sectional, descriptive and quantitative. Student t-test and Chi-square were the applied statistics. Statistical Package for Social Sciences (SPSS) version 26.0 was used for data analysis. Factor VIII, fibrinogen, proteins C and S activity levels were determined on ACL 200 coagulation analyser; CD4+ T cell count was performed on CD4 PIMA analyser; full blood count was performed on AcT.5 diff Haematology analyser and HIV-1/2 Ag/Ab combo test devices were used for HIV screening. The prevalence rates for HIV-naïve and ART groups were respectively as follows: Anaemia = 13.0%, 11.9%; leukopenia =20.9%, 31.0%; thrombocytopenia = 9.0%, 7.6%; low CD4+ T cell count = 10.1%, 14.3%; high protein C=19.4%, 15.7%; high protein S=31.3%, 24.0%; hyperfibrinogenaemia =43.3%, 15.5% and FVIII hyperactivity =35.8%, 27.4%. Differential counts: 35% neutrophils, 35% metamyelocytes and 30% band cells; marked red blood cell anisocytosis, deep basophilic lymphocytes and monocytes and, giant platelet with reduced granulation. On this basis, HIV infection and ART had impact on the haematological parameters

Homocysteine levels in individuals with and without metabolic syndrome in a rural black community of Ga-Mothapo in the Limpopo Province, South Africa

Metabolic syndrome (MS) represents a major public health problem that should be identified in individuals. By prediction, about 300 million people will have developed MS by 2030. The purpose of the study was to determine the levels of homocysteine (Hcy) in individuals and compare these levels in MS and non-MS individuals and, to determine the relationship between MS and Hcy. The study was cross-sectional, prospective and quantitative. The sample consisted of 382 individuals aged 18-65 years. Fasting blood samples were analysed for glucose, triglycerides and high density lipoprotein-cholesterol using ILab 300 Plus Chemistry System Analyser. Homocysteine was determined using the Beckman Coulter SYNCHRON System Analyser. Blood pressure was measured using the Omron MI-5 device. Diagnosis of MS was done according to National Cholesterol Education Programme criteria. The mean ages (years) of participants were 52.50 ± 11.067 and 35.76 ± 14.886 for MS and non-MS, respectively (p = 0.000). Homocysteine levels were 10.68 ± 3.433 μmol/L and 9.23 ± 2.924 μmol/L for MS and non-MS, respectively (p = 0.000). Metabolic syndrome was significantly associated with Hcy (r=0.132, p = 0.010). In bivariate regression, age, systolic and diastolic blood pressures and triglycerides increased the likelihood of hyperhomocysteinaemia by 1.07 times (p = 0.000), 1.03 times (p = 0.000), 1.05 times (p = 0.004) and 7.15 times (p = 0.020), respectively. In multivariate modelling age was a significant predictor of hyperhomocystenaemia. The study indicated significantly high levels of Hcy in MS than in non-MS (p = 0.010) and significant association of Hcy with MS.Keywords: Homocysteinaemia, metabolic syndrome, hyperglycaemia, hypertriglyceridaemia, HDL-C, hypertension

In vitro immune-modulatory potential of crude extract of leaf of Albizia gummifera against stimulated peripheral blood mononuclear and raw cells

Background: Albizia species including A. gummifera have been used in folk medicine for the treatment of various conditions by many cultural groups. Apart from its anti-parasitic and antimicrobial activity associated with its use, Albizia gummifera have not been investigated for either its anti-inflammatory properties or anti-proliferative effect in vitro.Materials and Methods: Extracted acetone crude extract of plant material was tested for the presence of various secondary metabolites using chemical tests while the anti-proliferative effect against peripheral blood mononuclear were tested using the WST-1 assay. Nitric oxide production by RAW cell line exposed to extract was also tested using Griess assay as well as the production of interleukin- 2 in medium of cultured PMBC using an enzyme-linked-immunosorbent assay (ELISA) kit.Results: Phytochemical testing of acetone leaf extracted was shown to be positive for flavonoids, saponins and tannins. The extract was shown to dose-dependently inhibited proliferation of mononuclear cells while promoting that of RAW cells (p<0.05). The production of IL-2 by mononuclear cells and nitric oxide release by RAW cells were inhibited and stimulated respectively (p<0.05) in both cell types. The extract was also shown to elicit significant anti- and pro-inflammatory potential at concentration above 20 and 40 μg/ml, in both cell types respectively.Conclusion: Further laboratory research is required to elucidate the anti- and pro-inflammatory biochemical pathways as shown by the in vitro immune-modulatory modalities of this plant species. It is also important to further identify bioactive entities of Albizia gummifera responsible for the observed activities.Key words: Albizia gummifera, cell proliferation, Interleukin-2, nitric oxide, phytochemistry

Tobacco use among ARV treated HIV infected rural South Africans : prevalence and its determinants

Tobacco use remains one of the major cardiovascular risk factors and its use in antiretroviral (ARV) treated human immunodeficiency virus (HIV) infected people may lead to activation of immune cells and rendering them more susceptible to HIV. We determined the prevalence of and factors associated with tobacco use in an antiretroviral treated HIV infected rural African people. The study was a cross-sectional, conducted in three ARV clinics in rural Dikgale Health and Demographic Surveillance System (HDSS), South Africa. Socio-demographic, tobacco and alcohol use data were collected using World Health Organisation stepwise approach to surveillance (STEPS) questionnaire. The Chi-square test was used to compare categorical variables between tobacco users and non tobacco users. The multiple logistic regression analysis was used to determine the predictors of tobacco use status. Of 214 ARV treated HIV infected participants, 171 (79.9%) were females and 43 (20.1%) were males. The mean age of participants was 44.8 ± 11.8 years. About 45 (21%) of participants were tobacco users. A higher proportion of males than females (39.5% versus 16.4%, p=0.02) used tobacco. Older age >50years (p=0.01), marital status (p=0.03) and alcohol consumption (p=0.001) were significant independent predictors of tobacco use. Tobacco use among ARV treated HIV infected rural people was common. Older age, alcohol consumption and marital status were the risk factors for tobacco use. There is need to scale up the awareness on how tobacco use, apart from being a risk factor for CVD, interferes with viral suppression despite treatment with antiretroviral drugs.Keywords: Tobacco Use, Cardiovascular Disease, Antiretroviral, Human Immunodeficiency Viru

Genetic diversity and distribution of Mycobacterium tuberculosis genotypes in Limpopo, South Africa

Abstract Background Tuberculosis remains a major health problem and knowledge of the diversity of Mycobacterium tuberculosis strains in specific geographical regions can contribute to the control of the disease. This study describes the genetic profile of M. tuberculosis in five districts of Limpopo Province. Methods A total 487 isolates were collected from the National Health Laboratory Services from all regions/districts of Limpopo Province. Only 215 isolates were confirmed to be M. tuberculosis by Bactec Mycobacterium Growth Indicator Tube 960® and Rhodamine-Auramine staining. Isolates were subcultured on Löwenstein-Jensen medium agar slants to validate purity. They were spoligotyped and data analysed using the international spoligotyping database 4 (SpolDB4). Results Of the 215 isolates, 134 (62.3%) were genotyped into 21 genotype families while 81 (37.7%) were orphans. The 81 orphans were further subjected to resolution employing SpolDB3/RIM. Overall, the study revealed a high diversity of strains of 32 predominantly the non-Beijing lineages: the LAM- LAM3 (9.8%), LAM9 (4.7%) and LAM11- ZWE (3.3%), the T-T1(15.0%), T2 (0.9%), T2-T3 (1.4%), the CAS-CAS1-Delhi 5 (1.9%) and CAS1-KILI (1.4%) the MANU2 (1.4%), U (0.5%), X-X1(1.4%), X3 (1.9%), S (9.8%), CAS (1.4%), LAM7(0.9%), T3(0.5%), LAM8(4.7%), T4(1.4%), X2(0.4%), AI5(1.9%), LAM1(0.5%), FAMILY33 (1.9%), EAI4(1.4%), M. microti (1.9%). The Beijing and Beijing-like families were (14.9%) and (0.9%), respectively. A total of 28(13%) clusters and 77(36%) unique cases were identified. Beijing strain (SIT 1) formed the biggest cluster constituting 14%, followed by LAM3 (SIT 33), T1 (SIT 53) and LAM4 (SIT 811) with 7%, 5.1% and 2.8%, respectively. The Beijing family was the only genotype found in all the five districts and was predominant in Mopani (18.8%), Sekhukhune (23.7%) and Vhembe (23.3%). Dominant genotypes in Capricorn and Waterberg were LAM3 (11.9%) and T1 (13.3%), respectively. Conclusion A wide diversity of lineages was demonstrated at district level. A high number of clusters per district provided evidence of on-going transmission in this Province

Estimating the burden of cardiovascular risk in community dwellers over 40 years old in South Africa, Kenya, Burkina Faso and Ghana

Introduction Cardiovascular disease (CVD) risk factors are increasing in sub-Saharan Africa. The impact of these risk factors on future CVD outcomes and burden is poorly understood. We examined the magnitude of modifiable risk factors, estimated future CVD risk and compared results between three commonly used 10-year CVD risk factor algorithms and their variants in four African countries.Methods In the Africa-Wits-INDEPTH partnership for Genomic studies (the AWI-Gen Study), 10 349 randomly sampled individuals aged 40–60 years from six sites participated in a survey, with blood pressure, blood glucose and lipid levels measured. Using these data, 10-year CVD risk estimates using Framingham, Globorisk and WHO-CVD and their office-based variants were generated. Differences in future CVD risk and results by algorithm are described using kappa and coefficients to examine agreement and correlations, respectively.Results The 10-year CVD risk across all participants in all sites varied from 2.6% (95% CI: 1.6% to 4.1%) using the WHO-CVD lab algorithm to 6.5% (95% CI: 3.7% to 11.4%) using the Framingham office algorithm, with substantial differences in risk between sites. The highest risk was in South African settings (in urban Soweto: 8.9% (IQR: 5.3–15.3)). Agreement between algorithms was low to moderate (kappa from 0.03 to 0.55) and correlations ranged between 0.28 and 0.70. Depending on the algorithm used, those at high risk (defined as risk of 10-year CVD event >20%) who were under treatment for a modifiable risk factor ranged from 19.2% to 33.9%, with substantial variation by both sex and site.Conclusion The African sites in this study are at different stages of an ongoing epidemiological transition as evidenced by both risk factor levels and estimated 10-year CVD risk. There is low correlation and disparate levels of population risk, predicted by different risk algorithms, within sites. Validating existing risk algorithms or designing context-specific 10-year CVD risk algorithms is essential for accurately defining population risk and targeting national policies and individual CVD treatment on the African continent