HLB-SIMPLe Small
Research Projects

Dr Nomathemba Chandiwana has been awarded a SRP Grant to study Obstructive Sleep Apnea in People with HIV

Antiretroviral therapy (ART) has dramatically improved the life expectancy of people with HIV (PWH), and non-communicable diseases such as cancer, diabetes mellitus (DM) and cardiovascular disease (CVD) are increasingly important causes of morbidity and mortality in this population.

Obstructive sleep apnea (OSA), the most common respiratory sleep disorder, is associated with increased risk for cardiometabolic disease (1). HIV, has been found to be an additional risk factor of OSA, even in young and non-obese patients (2, 3), though its impact on cardiometabolic health is not well characterised in Africa. Despite the potential impact of OSA on quality of life and cardiometabolic health, there is limited data among PWH in southern Africa where both HIV and obesity are at epidemic levels and cardiometabolic comorbidities are common. Understanding the extent of the problem is a critical first step towards developing appropriate interventions for resource-constrained high HIV burden settings such as South Africa.

This small research project proposes to address this gap through two approaches: a cross sectional study to describe the frequency of OSA amongst PWH enrolled in the ADVANCE study, and to investigate the association between OSA and cardiometabolic health. Aim 2 will leverage longitudinal clinical data collected over four years, including inflammatory markers, associated with chronic HIV, weight change and body fat distribution, and occurrence cardiovascular disease to describe the correlates between OSA and cardiometabolic health in PWH.

Nomathemba is, currently, a Senior Research Clinician at Ezintsha (a division of Wits Health Consortium). Through her work, she’s gained experience in conducting large scale HIV clinical trials in Africa. Notably, she is a sub-investigator in the ongoing ADVANCE trial, where the ART-emergent obesity signal was first documented in a randomised controlled trial. Through the experience gained in ADVANCE, and other HIV studies, she is uniquely qualified to benefit from this

training grant and translate her experience into key contributions to African health research and policy.

References

1. Krittanawong C, Liu Y, Mahtta D, Narasimhan B, Wang Z, Jneid H, Tamis-Holland JE, Mahboob A, Baber U, Mehran R, Wilson Tang WH, Ballantyne CM, Virani SS. Non-traditional risk factors and the risk of myocardial infarction in the young in the US population-based cohort. International journal of cardiology Heart & vasculature. 2020;30:100634. Epub 2020/10/01. doi: 10.1016/j.ijcha.2020.100634. PubMed PMID: 32995474; PMCID: PMC7516292.

2. Owens RL, Hicks CB. A Wake-up Call for Human Immunodeficiency Virus (HIV) Providers: Obstructive Sleep Apnea in People Living With HIV. Clin Infect Dis. 2018;67(3):472-6. Epub 2018/05/11. doi: 10.1093/cid/ciy217. PubMed PMID: 29746617; PMCID: PMC7958931.

3. Patil SP, Brown TT, Jacobson LP, Margolick JB, Laffan A, Johnson-Hill L, Godfrey R, Johnson J, Reynolds S, Schwartz AR, Smith PL. Sleep disordered breathing, fatigue, and sleepiness in HIV-infected and -uninfected men. PLoS One. 2014;9(7):e99258. Epub 2014/07/06. doi: 10.1371/journal.pone.0099258. PubMed PMID: 24991815; PMCID: PMC4084642.