Table 1.

Key defining studies^a from LMICs of HIV and non-communicable cardiovascular and pulmonary diseases

Disease	Reference	Country	Sample	HIV+ (n)	HIV− (n)	Study type	Brief Study Description	Key findings
Heart Failure	Hakim, et al. 1996 [10]	Zimbabwe	157	157	0	P,O	Echocardiographic study	50% of patients had dilated cardiomyopathy, left ventricular systolic dysfunction, isolated right ventricular dilatation, or pericardial disease
	Niakara, et al. 2002 [11]	Burkina Faso	79	79	0	R	Prevalence of cardiac diseases found among HIV patients	Common cardiac diseases in HIV+ patients were systolic HF, myocarditis, pericarditis, PAH, pulmonary embolism, and MI.
	Longo-Mbenza, et al. 1997 [12]	Zaire	332	166	166	P,O	Echocardiographic study of HIV+ and HIV− patients	Higher incidence of echocardiographic abnormalities in HIV+ patients. Worse systolic function in HIV+ patients.
	Longo-Mbenza, et al. 1998 [13]	Congo	157	157	0	P,O	Longitudinal echocardiographic study of risk factors for developing cardiac pathologies	Low socio-economic status and pericardial effusion were independent predictors of death.
	Nzuobontane, et al. 2002 [15]	Cameroon	75	54	21	P,O	Echocardiographic study of HIV+ and HIV− patients	Low CD4 cell count was associated with dilated cardiomyopathy.
	Twagirumukiza, et al. 2007 [16]	Rwanda	416	416	0	P,O multicenter	Echocardiographic study of patients not receiving HAART	Predictors of dilated cardiomyopathy were low socioeconomic status, duration of HIV infection, CD4 count, HIV viral load, advanced stage of HIV and low plasma level of selenium.
	Sliwa, et al. 2012 [18]	South Africa	5328	518	4810	P clinical registry	Description of all cases where HIV was concurrently diagnosed among patients admitted with de novo heart disease	HIV-related cardiac disease a minor contributor to overall disease burden (<4% prevalence). Cardiomyopathy (systolic and diastolic dysfunction) was the most common HIV-related cardiac disease.
	Damasceno, et al. 2012 [20]	Multiple	1006 (500 HIV tested)	65	435	P,O multicenter	Registry of patients admitted with acute heart failure. A subset of the population was tested for HIV	HIV-associated cardiomyopathy (systolic dysfunction) was rare (<3% prevalence).
	Tantchou Tchoumi, et al. 2011 [21]	Cameroon	462	7	455	P,O	Description of patients admitted with heart failure	1.6% of cases with HIV-associated cardiomyopathy (systolic dysfunction).
	Chillo, et al. 2012 [22]	Tanzania	102	102	0	P,O	Echocardiographic study to diagnose cardiac abnormalities in HIV+ patients	10% of HIV+ patients with cardiomyopathy (systolic dysfunction), 34% with hypertensive heart disease.
	Longenecker, et al. 2011 [23]	Uganda	82	41	41	P,O	Echocardiographic study of pregnant women with and without HIV to look for signs of cardiomyopathy and pulmonary hypertension and to examine outcomes.	HIV was not associated with any echocardiographic signs of cardiomyopathy (systolic dysfunction). Unexpectedly, HIV was associated with a slightly lower RVSP, but the number of observations was small. Maternal and fetal outcomes were similar for HIV+ and HIV− patients.
	Sliwa, et al. 2011 [24]	South Africa	80	27	53	P,O	Description of clinical outcomes and mortality among patients with a first time diagnosis of peripartum cardiomyopathy stratified by HIV status	No statistically significant difference in LVEF and mortality was observed between patients with peripartum cardiomyopathy with and without HIV infection. These patients had continuous high mortality occurring beyond 6 months independent of HIV infection and subsequent pregnancy.
HTN	Bloomfield, et al. 2011 [32]	Kenya	12,194	12,194	0	R	Description of patterns of hypertension and obesity among HIV+ adults	Overweight/obesity was more strongly associated with hypertension among HIV+ men than a higher successive age category. Among women, higher age category and overweight/obesity were most strongly associated with hypertension. Length of time on protease inhibitors was not found to be related to hypertension for men or women after adjustment.
	Mateen, et al. 2013 [33]	Sub-Saharan Africa	5563	5563	0	P,O	Assessment of blood pressure in HIV+ patients over the first year following initiation of HAART	HTN was diagnosed in 28% of patients. Almost all women were in the 10% or less 10-year Framingham Risk Score category, but 20% of men were at least 10% or more.
	Nyabera, et al. 2011 [34]	Kenya	5786	4629	1157	P	Implemention of a project for integration of cardiovascular risk factors and disease evaluation and management into HIV care and treatment programs	High blood pressure was present in 19% of the HIV− and 32% of the HIV+ patients. Authors note cardiovascular disease can be identified early among HIV infected patietns through routine integrated activities.
	Schwartz, et al. 2011 [35]	Botswana	179	179	0	P,O	Description of cardiac abnormalities among patients with HIV	HIV infection was strongly associated with pericarditis and cardiomyopathy. 18% of HIV+ patients with hypertensive heart disease (20% in HIV−).
	Sani, et al. 2011 [36]	Nigeria	200	200	0	P,O	Descriptive study of cardiovascular risk factors in treated and treatment-naïve HIV+ patients	17% prevalence of HTN in patients on HAART, 2% in HAART-naïve. Higher prevalence of dyslipidemia in treated vs. HAART-naïve patients.
	Adewole, et al. 2010 [37]	Nigeria	174	174 (130 on ART)	0	P,O	Comparison of serum lipid profiles among HIV+ patients based on whether or not they were receiving HAART	HIV+ patients who were not treated with HAART had higher LDL and lower HDL levels compared to patients who did receive HAART. No relationship between hypertension and lipid parameters.
CAD/MI/Atherosclerosis	Becker, et al. 2010 [47]	South Africa	60	30	30	P,O	Comparison of clinical and angiographic features of treatment-naïve HIV+ and HIV− patients with acute coronary syndrome	HIV+, treatment-naïve patients presenting with ACS were younger and were more likely to be smokers compared to HIV− patients. However, these HIV+ patients had fewer risk factors than the control group, including less hypertension, diabetes, hyperlipidemia, and other coronary risk factors. HIV+ patients had less atherosclerosis but higher degree of large thrombus burden. Stents were used to a similar degree in the HIV+ and HIV− groups.
	Becker, et al. 2011 [48]	South Africa	60	30	30	P,O	Comparison of thrombotic profiles of treatment-naïve HIV+ patients and HIV− patients with acute coronary syndrome	Treatment-naïve HIV+ patients with ACS were younger with fewer traditional risk factors but a higher degree of thrombophilia compared to HIV− patients.
	Lazar, et al. 2009 [50]	Rwanda	343	276	67	P,O	Assessment of differences in arterial wave reflection, a marker of atherosclerosis, in HIV+ vs. HIV− women	HIV infection not associated with increased arterial wave reflection in women with little exposure to antiretroviral therapy and without cardiovascular risk factors.
Stroke	Hoffmann, et al. 2000 [58]	South Africa	1298	24	NR	R, case-control study	Comparison of stroke characteristics of young, black, HIV+ patients in a stroke registry compared to historical HIV− controls	Large vessel cryptogenic stroke 2.5 times more common in HIV+ compared to HIV−.
	Patel, et al. 2005 [59]	South Africa	293	56	154	R	Comparison of etiologies of stroke among young (<44 years) HIV+ and HIV− patients	No difference in stroke etiologies between young HIV+ and HIV− patients without AIDS.
	Tipping, et al. 2007 [60]	South Africa	1087	67	1020	P,O	Comparison of etiologies of stroke among HIV+ and HIV− patients	HIV+ young stroke patients did not demonstrate hypertension, diabetes, hyperlipidemia, or smoking as significant risk factors for ischemic stroke. Primary etiologies of ischemic stroke included infectious meningitis/ vasculitides, coagulopathy, cardioembolism.
	Heikinheimo, et al. 2012 [61]	Malawi	147	50	97	P,O	Comparison of outcomes after stroke among HIV+ and HIV− patients	Poor outcomes after stroke were related to stroke severity and female gender but not to presence of HIV infection. HIV+ patients were younger and did not have many of the common risk factors for stroke. HIV+ patients more often suffered from ischemic stroke than HIV− patients.
OLD	Hnizdo, et al. 2000 [77]	South Africa	1343	305	1038	R	Examination of the chronic effect of initial and recurrent TB on lung function impairment with a subanalysis examining HIV+ vs. HIV− patients	TB infection caused chronic impairment of lunch function which increased incrementally with the number of episodes of TB and was not affected by HIV status.
	Ramin, et al. 2008 [80]	Ethiopia	153	43	110	P,O	Comparison of the outcomes in patients with and without TB who smoked with a subanalysis examining HIV status	Cigarette smoking and HIV status were the 2 key risk factors for TB infection.
PAH	Stewart, et al. 2011 [88]	South Africa	697 (141 with PAH)	43	98	P clinical registry	Examination of the characteristics and pathways to right heart failure	PAH due to HIV in 33% of women and 23% of men.

Abbreviations: LMIC, low- and middle-income country; HIV+, human immunodeficiency seropositive; HIV−, human immunodeficiency virus seronegative; HF, heart failure; PAH, pulmonary arterial hypertension; MI, myocardial infarction; P, prospective; O, observational; R, retrospective; HAART, highly active antiretroviral therapy; CDC, Centers for Disease Control; AIDS, acquired immune deficiency syndrome; NR, not reported; HTN, hypertension; LDL, low-density lipoprotein; HDL, high density lipoprotein; CAD, coronary artery disease; ACS, acute coronary syndrome; OLD, obstructive lung disease; TB, tuberculosis;

^aObservational or intervention studies conducted in LMICs that examined the relationship between HIV status or therapy and selected non-communicable cardiovascular and pulmonary diseases based on published data between 1996 and present