Cardiovascular disease‐related mortality and factors associated with cardiovascular events in the TREAT Asia HIV Observational Database (TAHOD)

Abstract

Objectives With aging of the HIV‐positive population, cardiovascular disease (CVD) increasingly contributes to morbidity and mortality. We investigated CVD‐related and other causes of death (CODs) and factors associated with CVD in a multi‐country Asian HIV‐positive cohort. Methods Patient data from 2003–2017 were obtained from the Therapeutics, Research, Education and AIDS Training in Asia (TREAT Asia) HIV Observational Database (TAHOD). We included patients on antiretroviral therapy (ART) with > 1 day of follow‐up. Cumulative incidences were plotted for CVD‐related, AIDS‐related, non‐AIDS‐related, and unknown CODs, and any CVD (i.e. fatal and nonfatal). Competing risk regression was used to assess risk factors of any CVD. Results Of 8069 patients with a median follow‐up of 7.3 years [interquartile range (IQR) 4.4–10.7 years], 378 patients died [incidence rate (IR) 6.2 per 1000 person‐years (PY)], and this total included 22 CVD‐related deaths (IR 0.36 per 1000 PY). Factors significantly associated with any CVD event (IR 2.2 per 1000 PY) were older age [sub‐hazard ratio (sHR) 2.21; 95% confidence interval (CI) 1.36–3.58 for age 41–50 years; sHR 5.52; 95% CI 3.43–8.91 for ≥ 51 years, compared with < 40 years], high blood pressure (sHR 1.62; 95% CI 1.04–2.52), high total cholesterol (sHR 1.89; 95% CI 1.27–2.82), high triglycerides (sHR 1.55; 95% CI 1.02–2.37) and high body mass index (BMI) (sHR 1.66; 95% CI 1.12–2.46). CVD crude IRs were lower in the later ART initiation period and in lower middle‐ and upper middle‐income countries. Conclusions The development of fatal and nonfatal CVD events in our cohort was associated with older age, and treatable risk factors such as high blood pressure, triglycerides, total cholesterol and BMI. Lower CVD event rates in middle‐income countries may indicate under‐diagnosis of CVD in Asian‐Pacific resource‐limited settings.

Statins for atherosclerotic cardiovascular disease prevention in people living with HIV in Thailand: a cost‐effectiveness analysis

“…Modelled incidence rates for MI, ischaemic stroke and fatal CVD among the no statin group were 4.7, 2.2 and 2.5 per 1000 person‐years respectively. These figures are consistent with observed rates of CVD reported for similarly aged participants in TAHOD [71]. The all‐cause mortality rate in the no statin group was 33.9 per 1000 person‐years and, over the next 20 years, patients were projected to accumulate a discounted average of 12.211 QALYs, 12.266 life‐years and 755,076 Baht ($US24,232) in direct medical costs (Table 3).…”

Plasma hemoglobin and the risk of death in HIV/AIDS patients treated with antiretroviral therapy

“…The effect of HB is much more evident in PLHIV whose TC is more than 4.08 mmol/L. Bijker R and colleagues demonstrated that cardiovascular disease (CVD) has become an increasingly significant contributor to morbidity and mortality among PLHIV, who are prone to developing coronary heart disease during long-term ART initiation [ 23 ]. The identified plausible biological mechanisms, including endothelial dysfunction and arterial inflammation, can provide reasonable explanations for the association [ 24 ].…”

Incidence of stroke in patients with HIV infection: A population-based study in Taiwan

“…One recent study in Taiwan showed the incidence rates of total stroke, ischemic stroke, and hemorrhagic stroke were 2.53 vs. 1.4; 1.87 vs. 1.01; 0.66 vs. 0.39 per 1000 person-years in the HIV cohort compared with the non-HIV cohort [14]. Another recent study found 2.2 cardiovascular events per 1000 person-years in the TREAT Asia HIV Observational Database [25]. Our observations revealed that the incidence rate of overall stroke per 1000 person-years was 2.12 among patients with HIV infection and 1.98 among the comparison group, which is lower than the studies reported in Western countries [5, 7–9, 11, 12], but similar to those in Asia [14, 25].…”