Gender differences in the use of cardiovascular interventions in <scp>HIV</scp>‐positive persons; the D:A:D Study

Hatleberg, Camilla Ingrid; Ryom, Lene; El‐Sadr, Wafaa; Mocroft, Amanda; Reiss, Peter; Wit, Stéphane De; Dabis, François; Pradier, Christian; Monforte, Antonella d’Arminio; Kovari, Helen; Law, Matthew; Lundgren, Jens D; Sabin, Caroline

doi:10.1002/jia2.25083

Cited by 11 publications

(11 citation statements)

References 54 publications

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“…PLWH with these risk factors should be monitored and counseled on lifestyle changes. Being female and black ethnicity were associated with a lower risk of dyslipidemia, consistent with results from other studies [49,50]. Compared with ART-naive individuals, ART-experienced PLWH had a lower risk of dyslipidemia.…”

Section: Discussionsupporting

confidence: 90%

Incidence of dyslipidemia in people with HIV who are treated with integrase inhibitors versus other antiretroviral agents

Study¹,

Byonanebye

Polizzotto

et al. 2021

Aids

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Incidence of dyslipidemia in people with HIV who are treated with integrase inhibitors versus other antiretroviral agents The RESPOND Study Group M Objective: To compare the incidence of dyslipidemia in people with HIV receiving integrase inhibitors (INSTI) versus boosted protease inhibitors (PI/b) and nonnucleoside reverse transcriptase inhibitors (NNRTI) within RESPOND consortium of prospective cohorts. Methods: Participants were eligible if they were at least 18 years, without dyslipidemia and initiated or switched to a three-drug antiretroviral therapy (ART)-regimen consisting of either INSTI, NNRTI, or PI/b for the first time, between 1 January 2012 and 31 December 2018. Dyslipidemia was defined as random total cholesterol more than 240 mg/dl, HDL less than 35 mg/dl, triglyceride more than 200 mg/dl, or initiation of lipid-lowering therapy. Poisson regression was used to determine the adjusted incidence rate ratios. Follow-up was censored after 3 years or upon ART-regimen discontinuation or last lipid measurement or 31 December 2019, whichever occurred first. Results: Overall, 4577 people with HIV were eligible (INSTI ¼ 66.9%, PI/b ¼ 12.5%, and NNRTI ¼ 20.6%), 1938 (42.3%) of whom were ART-naive. During 1.7 (interquartile range, 0.6-3.0) median years of follow-up, 1460 participants developed dyslipidemia [incidence rate: 191.6 per 1000 person-years, 95% confidence interval (CI) 182.0-201.7]. Participants taking INSTI had a lower incidence of dyslipidemia compared with those on PI/b (adjusted incidence rate ratio 0.71; CI 0.59-0.85), but higher rate compared with those on NNRTI (1.35; CI 1.15-1.58). Compared with dolutegravir, the incidence of dyslipidemia was higher with elvitegravir/cobicistat (1.20; CI 1.00-1.43) and raltegravir (1.24; CI 1.02-1.51), but lower with rilpivirine (0.77; CI 0.63-0.94). Conclusion: In this large consortium of heterogeneous cohorts, dyslipidemia was less common with INSTI than with PI/b. Compared with dolutegravir, dyslipidemia was more common with elvitegravir/cobicistat and raltegravir, but less common with rilpivirine.

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Section: Discussionsupporting

confidence: 90%

Incidence of dyslipidemia in people with HIV who are treated with integrase inhibitors versus other antiretroviral agents

Study¹,

Byonanebye

Polizzotto

et al. 2021

Aids

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“…By contrast, the international D:A:D cohort of > 49 000 PLWH found many CVD risk factors to be more common in MLWH, including hypertension (7% vs. 10.8%) and diabetes (1.7% vs. 2.7%) [22].…”

Section: Resultsmentioning

confidence: 99%

Comorbidities in women living with HIV: A systematic review

2022

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Objectives Effective antiretroviral therapy (ART) has improved the life expectancy of women living with HIV (WLWH). This population is now experiencing age‐related comorbidities. This systematic review presents the current understanding of the prevalence and impact of comorbidities in WLWH in the modern ART era. Methods MEDLINE and Embase were searched for studies (1 January 2010 to 1 September 2020) reporting the prevalence of cardiovascular, bone, renal and neurocognitive disease in WLWH aged > 18 years. Studies were included if at least 100 participants (or > 50%) were female and data analysis included prevalence by sex. Results In all, 3050 articles were identified and screened; 153 full‐text articles were assessed for eligibility and 38 were included in the final review. Significant gaps in the literature were identified, notably a lack of data on WLWH aged > 50 years. The data suggest a high burden of cardiovascular, bone, renal and neurocognitive disease in WLWH compared with HIV negative women. Traditional risk factors, such as hypertension, diabetes and dyslipidaemia, were common and often poorly managed. Generalizability of the results was limited, as many studies were conducted in the USA. Comparisons between WLWH and men with HIV were limited by marked differences in demographic and socioeconomic factors. Conclusions Women living with HIV experience a high burden of comorbid disease. Traditional risk factors are common and often poorly managed. This review also highlights the magnitude of differences between women and men living with HIV beyond the pathophysiological. Future research must unpick the complex drivers of morbidity in WLWH, to improve the holistic management of this population.

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“…We also found that women with HIV were more prone to have CVE than their HIV-negative pairs, while this difference was not observed with men, even though the absolute IR in CoRIS was lower in women. Different causes have been implicated for this gender-dependent increased risk, such as a higher prevalence of atherosclerotic plaques in women with HIV [29], less monitoring of interventions to prevent cardiovascular risk in women with HIV [30], and increased immune activation associated with female gender [31]. The relevance of prevention is emphasized by the fact that mortality was twice-as-high in PLWH with vascular events compared to those without events.…”

Section: Discussionmentioning

confidence: 99%

Evolving understanding of cardiovascular, cerebrovascular and peripheral arterial disease in people living with HIV and role of novel biomarkers. A study of the Spanish CoRIS cohort, 2004-2015

et al. 2019

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Objectives To analyze the incidence rates (IR) and spectrum of vascular events in people living with HIV (PLWH) in Spain from 2004 to 2015. Serial measurements of different plasma cardiovascular biomarkers were assessed in relation to disease development. Methods Longitudinal study in a nationwide contemporary multicenter cohort of PLWH. A nested case-control study was performed to evaluate the predictive value of cardiovascular biomarkers. Additive generalized and Cox mixed models were used for the analyses. Results 9,712 PLWH and 48,341 person-years of follow-up were analysed. During 2004–2015, 147 persons developed 154 vascular events; 80 (54.42%) coronary-related; 65 (44.22%) cerebrovascular-related, and 9 (6.12%) peripheral arterial disease. The 2004–2015 IR (95% confidence interval) of vascular events was 3.17 (2.69–3.71) x1,000 person-years; 1.64 (1.30–2.05) for coronary events; 1.34 (1.03–1.70) for cerebrovascular events; and 0.19 (0.09–0.35) for peripheral arterial disease (p<0.001). IR of vascular events gradually increased from 0.37 (0.12–0.85) x1,000 patient-years in the stratum 25-34-years to 19.65 (6.38–45.85) x1,000 patient-years in the stratum 75-84-years. Compared to the general population, there was a higher incidence of acute myocardial infarction (AMI) in men (sIR ratio 1.29 [95% CI 1.16–1.42]), of cerebrovascular events in women (sIR ratio 2.44 [95% CI 1.68–3.19]), and of both types of events specifically among the younger age-strata. CD4 count (hazard ratio 0.80, [95% CI, 0.79–0.81]), age (1.86 [1.47–2.34] for 45–65 years and 3.44 [2.37–4.97] for >65 years) and vascular event (1.81 [1.12–2.94]) were associated with total mortality. Adjusted levels of intercellular-adhesion-molecule (sICAM), pro-b-type-natriuretic-peptide (pro-BNP) and marginally sCD14, were higher among patients who subsequently developed vascular events. Conclusion Vascular events in PLWH do preferentially occur in the older age-strata, they are associated with increased mortality and, compared to the general population, the excess risk occurs at younger ages. Peripheral arterial disease is unusual. Vascular events are preceded by increased levels of sICAM, pro-BNP and, marginally, sCD14.

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Gender differences in the use of cardiovascular interventions in HIV‐positive persons; the D:A:D Study

Cited by 11 publications

References 54 publications

Incidence of dyslipidemia in people with HIV who are treated with integrase inhibitors versus other antiretroviral agents

Incidence of dyslipidemia in people with HIV who are treated with integrase inhibitors versus other antiretroviral agents

Comorbidities in women living with HIV: A systematic review

Evolving understanding of cardiovascular, cerebrovascular and peripheral arterial disease in people living with HIV and role of novel biomarkers. A study of the Spanish CoRIS cohort, 2004-2015

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