HIV related stigma, perceived social support and risk of premature atherosclerosis in South Asians.

Objective: This study sought to determine the association between social support and stigma experienced by HIV-positive patients and presence of subclinical cardiovascular disease.

Methods: We implemented a cross sectional study in 67 HIV-positive patients and 52 controls from a community health care center in central India. The participants underwent an in-depth survey and a clinical and laboratory assessment of cardiovascular risk. Carotid-intimal thickness (CIMT) was used as a marker of subclinical cardiovascular disease.

Results: On comparing the HIV and age and sex-matched control population, HIV patients had lower body weight (P=<0.001), and lower systolic blood pressures (P=0.002). Despite the lack of higher cardiac risk factor prevalence and lower lipid abnormalities, HIV patients had higher right, left and average CIMT values than controls (P<0.001 for all). HIV patients also showed higher prevalence of abnormal CIMT (≥ 0.9mm) than controls (32% vs. 0%, P<0.001). HIV patients with increased CIMT (n=37) in comparison with those with normal CIMT (n=30) were more frequently males (P=0.023), had higher systolic blood pressures (P=0.002), lower CD4 counts (P=0.033) and experienced higher enacted stigma (P=0.044). On multivariable stepwise logistic regression, systolic blood pressure (odds ratio:1.06, P=0.002) and stigma score > 25 percentile value (odds ratio:3.84, P=0.037) were independent predictors of the abnormal CIMT.

Conclusions: HIV-positive patients from central India have a higher prevalence of abnormal CIMT as a marker of subclinical cardiovascular disease than the general population. This predisposition to increased cardiovascular risk may be related to complex interactions between HIV disease and stigma-related healthcare inequalities.