Hidden heart risks in people with HIV and tuberculosis in Nairobi

People living with HIV (PLWH) face a higher chance of heart problems such as atherosclerosis (clogged arteries) and myocardial dysfunction (weakening of the heart muscle), even when their virus is well controlled on antiretroviral therapy (ART). Yet most PLWH live in sub-Saharan Africa, and there are surprisingly few studies from the region that look for these structural heart changes. To fill that gap, the Early Structural Cardiovascular Disease, HIV, and Tuberculosis (ASANTE) study has been designed as a cross-sectional protocol led by corresponding author Saate Shakil. The study will be based in a public hospital in Nairobi, Kenya, and plans to enroll 400 participants balanced by sex (50% female) and HIV status (50% PLWH). Participants will undergo detailed heart imaging and have biological samples banked so researchers can look for hidden, early signs of heart disease and the factors that might cause them. ASANTE aims to document the presence of subclinical heart disease — changes that are present but not yet causing symptoms — in this understudied population.

ASANTE uses multimodal cardiovascular phenotyping to detect early heart disease. Imaging will include coronary CT angiography [CCTA] to look for coronary atherosclerosis and transthoracic echocardiography to evaluate subclinical myocardial dysfunction. In addition to imaging, the study will bank whole blood, peripheral blood mononuclear cells, serum, and urine so investigators can study traditional and non-traditional risk factors. The protocol explicitly plans to evaluate endemic infections, including latent tuberculosis, alongside standard cardiovascular risk measures. The study will recruit 400 people at a public hospital in Nairobi, Kenya, with equal representation by sex and HIV status, and will enroll people living with HIV who may be on antiretroviral therapy (ART). As a cross-sectional study protocol, the ASANTE abstract does not report results yet; rather, it defines how investigators will measure the prevalence of subclinical coronary atherosclerosis by CCTA and subclinical myocardial dysfunction by transthoracic echocardiography and how they will assess associated risk factors.

The ASANTE study is set to provide important baseline information about the types and frequency of early heart disease found in people with and without HIV in Nairobi. By combining modern imaging — coronary CT angiography [CCTA] and transthoracic echocardiography — with stored biological samples (whole blood, peripheral blood mononuclear cells, serum, urine), researchers will be able to relate structural heart changes to both common risk factors and local infections such as latent tuberculosis. This combination of tools and samples is designed to reveal phenotypes of HIV-associated cardiovascular disease in a region where such data are limited. Ethical approval has been granted by the University of Nairobi-Kenyatta National Hospital Ethical Review Committee, and the team plans to submit their results to peer-reviewed journals. Ultimately, the study aims to inform future research, surveillance, and possible interventions for early cardiovascular disease among people living with HIV in sub-Saharan Africa.