AfricaScienceNews, 6 May 2014

[Melbourne, Australia] African governments should begin to integrate cardiovascular disease awareness in HIV programmes, according to a special session on heart disease in Africa at the ongoing World Congress of Cardiology.

Prof Andre Pascal, Director of non-communicable diseases at the Medical Research Council of South Africa said given that 70 per cent of the 35 million people living with HIV (PLWH) globally are in Africa, any attempt to address any medical condition, including CVD in the continent should be done in the context of HIV.

According African experts at the Congress, over the past decade, substantial domestic and foreign investment has successfully scaled-up HIV/AIDS healthcare infrastructure in these countries and Africa already have some mileage on this and has succeeded in developing a parallel health care system to address HIV and related diseases like TB.

"This gives hope that if it chooses to integrate CVD in these programmes, there is real chance of Africa succeeding on CVD as it has on HIV," he said.

He said that all it may call for is training of health care workers, screening PLWH for CVD risks at the point they visit ART centres for their regular drug uptake and integrating CVD awareness campaigns to HIV prevention messages.

He said studies done in Tanzania show that people living with HIV show prove that HIV itself is a risk factor to CVD.

Prof Pascal said the study disclosed that PLWH have five times more chances of developing heart disease than the HIV negative individuals.

"If this is the case, the need for proactive integrating CVDs in HIV is more urgent," he suggested.

CVD expresses itself in three ways among the people who live with HIV, he said. One the fact that one has HIV itself is a risk factor to CVD among PLWH in itself...then there is CVD due to changes in lifestyle, heart disease as a result of malnutrition and finally the introduction of ARVs in treatment of PLWH.

The precursor is HIV itself and the ARV...which have increased lives of the PLWH and therefore not immune to lifestyle changes. But Prof Pascal said that although AIDS-related deaths appear to have stabilised over the years since the onset of ARVs, CVD on the other hand seems to be the new driver of non-AIDS-related deaths among people living with HIV.

He said 16 per cent of the 50 % of non-AIDS related deaths of PLWH is due to CVD.

He added that medics are too aware of the existing data that show PLWH on some ARV treatment have CVD events triggered somewhere along their lives.

But this, he said, should not offset the benefit of putting people on treatment as soon as possible once confirmed that they are HIV positive.

"No one person living with HIV should be denied ART even at the risk of CVD," added Dr Judith Namuyonga, a paediatrician from the Uganda Heart Institute, Mulago Hospital.

She added that what should happen is to increase screening and monitoring for CVD risks and managing the cases as soon as they happen.

Studies in Uganda also appear to support the call by Prof Pascal. According to C. T. Longenecker Existing, Case Western Reserve University and counterparts at the Makerere University, HIV/AIDS infrastructure can be successfully leveraged to provide quality care for patients with Rheumatic Heart Disease in Uganda.

They say such a program could serve as a model for the management of other chronic cardiovascular (and other non-communicable) diseases in resource limited settings where infrastructure for HIV/AIDS is robust, but other health infrastructure is lacking.

Written by Henry Neondo

Source: AfricaScienceNews