Reducing Cardiovascular Disease in People Living With HIV
People with HIV had similar control of most conditions except for triglycerides.
For people living with the human immunodeficiency virus (HIV), cardiovascular disease (CVD) is a serious concern. People with HIV have a higher incidence of heart failure and are 2 times as likely to develop CVD in comparison to those without the virus.
However, successfully managing certain conditions like hypertension, diabetes mellitus, and dyslipidemia is of key importance and can have a significant influence on the risk of CVD in those living with HIV.
Recently, investigators evaluated the extent to which people with HIV managed these conditions and how it influenced their risk of CVD. The data was presented during the Conference on Retroviruses and Opportunistic Infections (CROI) 2021 virtual sessions.
The study included 8,285 people with HIV (PWH) and 170,517 people without HIV (PWoH). The participants all had similar prevalence of hypertension (19% PWH; 22% PWoH), dyslipidemia (41% for both) and diabetes (8% PWH; 9% PWoH) and managed the conditions similarly. The cohort of PWH were aged ≥18 years and were 20:1 age-, sex-, race/ethnicity-matched with PWoH.
The participants were all members of an integrated healthcare system in Northern California between 2013 and 2017. Those with prevalent CVD such as coronary heart disease or ischemic stroke were excluded from the study.
The investigators computed the disease management index (DMI) which accounts for the amount and duration of person-time above treatment over 6-month intervals. They then used a Cox regression and computed hazard ratios (HR) for incident of CVD by overall HIV status.
Results from the study showed that PWH had 450 CVD events (20.8 per 1,000 person-years) and PWoH had 7,648 events (17.0 per 1,000 person-years), with an adjusted HR of 1.18 (95% CI 1.07-1.30). For PWH, factors such a smoking of consumption of alcohol only have a marginal association with a reduced DMI. There was no statistically significant elevated risk of CVD for PWH who controlled dyslipidemia (HR 1.10; 95% CI 0.91-1.34), and diabetes (HR 1.02; 0.72-1.42). However, the risk remained significant for those who successfully controlled hypertension (HR 1.35; 1.10-1.67).
