THE IMPACT OF REGULAR SCREENING AND LIFESTYLE MODIFICATION ON CARDIOVASCULAR DISEASE RISK FACTORS IN SOUTH AFRICAN WOMEN LIVING WITH HIV.

BACKGROUND: The ISCHeMiA study set out to determine the effectiveness of screening and lifestyle modification in modifying CVD risk factors in women living with HIV (WLHIV).

METHODS: In this prospective quasi-experimental intervention study, WLHIV aged 18-<50 years were enrolled from two clinics (intervention [I-arm) and control arms [C-arm]) in Umlazi, South Africa between November 2018 and May 2019. Women in the I-arm received lifestyle modification advice on diet, physical activity, alcohol use and smoking cessation and underwent annual screening for CVD risk. The CVD risk factors were assessed through standardised questionnaires, clinical and laboratory procedures at baseline and at end of three years of follow-up. Prevalence of metabolic syndrome (MetS) and other CVD indices were compared between arms at end-of-study (EOS).

RESULTS: Total of 269 WLHIV (149 I-arm and 120 C-arm) with mean+ SD age 36+1 years were included in the EOS analyses after 32+2 months of follow-up. The MetS prevalence at EOS was 16.8% (25/149) in the I-arm, and 24% (24/120) in the C-arm (RR 0.9; 95%CI 0.5-1.1; p 0.86). Proportion of women with fasting blood glucose>5.6mmol/L in the I-arm and C-arm were 2.7% (4/149) and 13.3% (16/120) respectively (RR 0.2;95%CI 0.069-0.646;p<0.01). High-density lipoprotein (HDL) improved with the intervention arm from baseline to EOS (95%CI [-0.157, -0.034];p<0.05).

CONCLUSIONS: While there was no significant difference in the prevalence of MetS between study arms, we observed decreased blood glucose levels in the I-arm compared to the C-arm, and improved HDL within the I-arm, following lifestyle modification and regular screening for CVD risk factors in WLHIV.