Prevalence and Risk Factors of Peripheral Arterial Occlusive Disease in Adult HIV Positive Patients in Indian Population: A Hospital Based, Cross Sectional Study

Suraj, S (2015) Prevalence and Risk Factors of Peripheral Arterial Occlusive Disease in Adult HIV Positive Patients in Indian Population: A Hospital Based, Cross Sectional Study. Masters thesis, Christian Medical College, Vellore.

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Abstract

BACKGROUND: HIV has been known to cause arterial occlusive disease by atherosclerotic and non-atherosclerotic mechanisms. The underlying pathophysiological mechanisms are not well studied. There are only limited studies assessing the prevalence and risk factors of peripheral arterial occlusive disease in this population. There are very few studies from the Indian subcontinent addressing this issue where the load of HIV is high. As we all know, the mortality and morbidity associated with this incurable condition is high. With availability of HAART (Highly active antiretroviral therapy), patients now live longer and presence of peripheral arterial occlusive disease is emerging as a clinically relevant problem. Presence of advanced HIV disease with low CD4 count and low albumin are poor prognostic factors for operative or non-operative management of vascular disease in this population. Rates of limb amputation with advanced disease can be higher. Detection at an early stage may help in instituting preventive measures which can help improve clinical outcome. This study mainly aims to determine the prevalence of peripheral arterial occlusive disease in this population using clinical features and Ankle Brachial Pressure Index (ABPI). The clinical details will be recorded in a proforma. AIM OF THE STUDY: To assess the prevalence of peripheral arterial occlusive disease in adult HIV positive patients and identify other possible risk factors for the development of peripheral arterial occlusive disease in this population OBJECTIVES: PRIMARY OBJECTIVE: To assess the prevalence of peripheral arterial occlusive disease in HIV positive adult patients aged >/= 18 years presenting to a tertiary care hospital of India during the time period December 2012 to September 2014. SECONDARY OBJECTIVE: To identify the possible risk factors for development of peripheral arterial occlusive disease in study population. METHODS: A prospective observational study was conducted in the department of General Surgery and Infectious Disease Training and Research Centre (IDTRC) in the Christian Medical College, Vellore from November 2012 to September 2014. All consenting HIV positive patients eligible for the inclusion criteria were included in the study. Methodology involved: explaining to the patient about details of study with the help of an information leaflet, obtaining informed consent and recruiting them into the study. A direct interview based on a proforma covering demography, symptomatology (assessed with help of Edinburgh Claudication Questionnaire), clinical and laboratory parameters and risk factors under study was done. Finally the primary outcome measurement using the screening tool (Ankle Brachial Pressure Index and or Toe pressure) and its documentation in the proforma was done. Data entry was done into an excel sheet. Statistical analysis was done using SPSS software. Prevalence of peripheral arterial occlusive disease and the significant risk factors for the causation of same was identified. RESULTS: A total of 403 HIV positive patients were recruited in to the study. Average age of study population was 41.45. There were 238 males and 165 females (59.1% Vs 40.1%). Claudication was reported by 19 patients (4.7%). Out of these 19 patients, 5 patients had final evidence of peripheral arterial disease. Prevalence of peripheral arterial occlusive disease (PAOD) was found to be 7.69% (n = 31). Out of these, 17 were females and 14 were males. 3 patients had >25% reduction in the post-exercise ABPI. But all these patients already had an abnormal ABPI (<0.9). Use of protease inhibitors and the duration of its use were identified to be strongly associated with causation of PAOD in this population. Traditional risk factors like diabetes mellitus, tobacco use including smoking, hypertension, and dyslipidaemia were not identified as independent risk factors for PAOD in this particular population. Duration of HIV infection, overall duration of HIV treatment and CD4 count < 300 were also found to be high risk factors for PAOD in this population, but did not attain statistical significance in multivariate analysis. CONCLUSION: Prevalence of peripheral arterial occlusive disease in HIV positive patients is high in comparison to the general population. Traditional risk factors seem to be playing negligible role in the development of peripheral arterial occlusive disease in these patients. Protease inhibitor use and duration of its use can be strongly associated with development of PAOD in this population. Hence drug regime has to be carefully selected.

Item Type: Thesis (Masters)
Uncontrolled Keywords: HIV ; peripheral arterial occlusive disease (PAOD) ; Ankle Brachial Pressure Index (ABPI) ; Toe pressure ; risk factors ; HAART.
Subjects: MEDICAL > General Surgery
Depositing User: Punitha K
Date Deposited: 04 May 2018 18:59
Last Modified: 04 May 2018 18:59
URI: http://repository-tnmgrmu.ac.in/id/eprint/7461

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