HIV Infection and Incidence of Cardiovascular Diseases: An Analysis of a Large Healthcare Database

Abstract

Background People living with HIV ( PLWH ) experience higher risk of myocardial infarction ( MI ) and heart failure ( HF ) compared with uninfected individuals. Risk of other cardiovascular diseases ( CVD s) in PLWH has received less attention. Methods and Results We studied 19 798 PLWH and 59 302 age‐ and sex‐matched uninfected individuals identified from the MarketScan Commercial and Medicare databases in the period 2009 to 2015. Incidence of CVD s, including MI , HF , atrial fibrillation, peripheral artery disease, stroke and any CVD ‐related hospitalization, were identified using validated algorithms. We used adjusted Cox models to estimate hazard ratios and 95% CI s of CVD end points and performed probabilistic bias analysis to control for unmeasured confounding by race. After a mean follow‐up of 20 months, patients experienced 154 MI s, 223 HF , 93 stroke, 397 atrial fibrillation, 98 peripheral artery disease, and 935 CVD hospitalizations (rates per 1000 person‐years: 1.2, 1.7, 0.7, 3.0, 0.8, and 7.1, respectively). Hazard ratios (95% CI ) comparing PLWH with uninfected controls were 1.3 (0.9–1.9) for MI , 3.2 (2.4–4.2) for HF , 2.7 (1.7–4.0) for stroke, 1.2 (1.0–1.5) for atrial fibrillation, 1.1 (0.7–1.7) for peripheral artery disease, and 1.7 (1.5–2.0) for any CVD hospitalization. Adjustment for unmeasured confounding led to similar associations (1.2 [0.8–1.8] for MI , 2.8 [2.0–3.8] for HF , 2.3 [1.5–3.6] for stroke, 1.3 [1.0–1.7] for atrial fibrillation, 0.9 [0.5–1.4] for peripheral artery disease, and 1.6 [1.3–1.9] for CVD hospitalization). Conclusions In a large health insurance database, PLWH have an elevated risk of CVD , particularly HF and stroke. With the aging of the HIV population, developing interventions for cardiovascular health promotion and CVD prevention is imperative.

Prediction of cardiovascular risk among male patients infected with human immunodeficiency virus in Vojvodina, Serbia: A single centre study

“…The trend of rising CVD mortality in HIV-infected individuals is growing in importance (14). In 2010, 19% of HIV-infected individuals had at least one CVD [15,16].…”

The case for an HIV cure and how to get there

“…Individuals might cope with physical manifestations of HIV-related and treatment-related symptoms for extended periods, including fatigue, weight gain, pain, discomfort, and restricted mobility; even when on stable, long-term ART, individuals can experience comorbidities. 28 , 29 , 30 People living with HIV also confront social and psychological challenges, such as the prospect of financial losses, depression, substance abuse, physical abuse, poor access to quality social support systems, and discrimination. 31 …”

Pattern of arterial inflammation and inflammatory markers in people living with HIV compared with uninfected people

“…17 These studies focused on patients with low cardiovascular risk; however, in clinical practice, many patients with HIV have a high cardiovascular risk based on conventional risk factors. 3 Therefore, we performed a prospective study of subjects without known cardiovascular disease but with at least 3 traditional risk factors, with the main aim to compare arterial inflammation, as assessed by 18 F-FDG-PET scan of ascending aorta (AA), descending aorta (DA), and carotid arteries (CAs) between PLWH and uninfected people.…”