Factors associated with incidence of stroke and heart failure among people living with HIV in Ghana: Evaluating Vascular Event Risk while on Long-Term Antiretroviral Suppressive Therapy (EVERLAST) Study

People living with HIV (PLWH) have a two-fold higher risk of cardiovascular diseases (CVDs) compared with HIV-negative populations. Although 70% of the global HIV population reside in Africa, data on CVD outcomes among PLWH are scarce. We seek to evaluate factors associated with incidence of stroke and heart failure in a prospective cohort of Ghanaian PLWH. We followed up a cohort of PLWH on antiretroviral therapy for 12 months to assess rates of clinically adjudicated stroke, and heart failure. We calculated incidence rates of events/1000 person-years and fitted Cox proportional hazards regression models to identify factors associated with incident stroke and heart failure as a combined outcome measure and as separate outcome measures. Among 255 participants, the mean age was 46 years and 211 (82.7%) were female. The participants contributed 245 years of follow-up data with mean follow-up duration of 11.5 months. There were three incident strokes giving an incidence rate of 12.24 per 1000 person-years (95% CI: 3.13-33.33) and two heart failure events with an incidence rate of 8.16 (95%CI: 1.37-26.97) per 1000 py. The combined event rate was 20.41 (95% CI: 7.48-45.24) per 1000 py. Being hypertensive was associated with aHR of 8.61 (1.32-56.04) of the combined outcome while each 100 cells/mm(3) rise in CD4 count was associated with aHR of 0.56 (0.35-0.88). Carotid bulb intimal media thickness was independently associated with stroke occurrence with aHR of 12.23 (1.28-117.07). People living with HIV on long-term cART in this Ghanaian sample have high rates of clinically adjudicated cardiovascular diseases driven by uncontrolled hypertension and persisting immunosuppression. Integration of CVD care into routine HIV management may help alleviate this untoward confluence of rising CVDs among PLWH.