Incidence of cardiovascular diseases in a nationwide HIV/AIDS patient cohort in Taiwan from 2000 to 2014

Abstract

The purpose of the study was to determine the incidence of cardiovascular disease (CVD) among people living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (PLWHA) in Taiwan. PLWHA were identified from the Taiwan Centers for Disease Control HIV Surveillance System between 2000 and 2014. To examine the effect of active antiretroviral therapy (HAART) on CVD incidence, incidence densities and standardised incidence rates (SIRs) of CVD were calculated after stratifying PLWHA by HAART. Of 26 272 PLWHA (mean age, 32.3 years) identified, 73.4% received HAART. Compared with general population, SIRs (95% confidence interval) were higher for incident coronary artery disease (1.11 (1.04-1.19)), percutaneous coronary intervention (1.32 (1.18-1.47)), coronary artery bypass surgery (1.47 (1.29-1.66)), sudden cardiac death (3.01 (2.39-3.73)), heart failure (1.50 (1.31-1.70)) and chronic kidney disease (1.95 (1.81-2.10)), but was lower for incident atrial fibrillation (0.53 (0.37-0.73)). Considering the effect of HAART on incident CVD, the SIRs for all-cause, ischaemic and haemorrhagic stroke were higher in PLWHA who did not receive HAART, but were lower in PLWHA who received HAART. PLWHA had higher risks of incident coronary artery disease, percutaneous coronary intervention, coronary artery bypass surgery, sudden cardiac death, heart failure and chronic kidney disease. HAART reduces risks of incident CVD in PLWHA.

HIV Infection and the Risk of World Health Organization–Defined Sudden Cardiac Death

“…To our knowledge, this is the largest study to date reporting that PLWH have an excess risk of SCD and the only national study to compare PLWH with a demographically and behaviorally (eg, substance use and abuse) similar uninfected reference population that included adjudicated SCDs. These findings are consistent with earlier reports by our group and others of an excess risk of SCD among PLWH 9 , 11 , 12 and extend prior work by including participants without existing heart failure and assessing the impact of time‐updated viral load status and immune function over a median follow‐up period of 9 years. Notably, the magnitude of increased SCD risk in HIV‐infected versus uninfected veterans in the current study is substantially lower than our 2012 study, which compared SCD rates in our specialty HIV clinic over 10 years with the expected SCD rate in the uninfected county‐wide population.…”

“… 9 , 10 Whether HIV infection is an independent risk factor for SCD, however, is unclear because data are sparse. 9 , 11 , 12 The largest study conducted to date was our single‐site study involving 2860 patients at an HIV clinic in San Francisco. 9 We reported a rate of SCD among PLWH that was 4.5‐fold higher than expected compared with the general population, but our study did not account for differences in prevalence of cardiovascular risk factors between groups.…”

Sudden Cardiac Death and Sudden Cardiac Arrest in Patients with Human Immunodeficiency Virus: A Systematic Review

“…In this systematic review, we included seven studies that reported the effect of HIV on SCD; five studies analyzed the association between SCD and HIV; Yen et al [ 8 ] reported a higher incidence rate of SCD in PLWH than non-HIV patients, 68.31 and 9.31 per 100,000 persons per year, respectively. Lai et al [ 9 ] reported that compared with the general population, PLWH had a higher risk of incident coronary artery disease, percutaneous coronary intervention, coronary artery bypass surgery, SCD, heart failure, and chronic kidney disease but had a lower risk of atrial fibrillation. Tseng et al [ 12 ] reported that SCD account for most cardiac and many non-AIDS natural deaths in PLWH.…”

“…Among 150 SCD events, 97 (64.7%) and 53 (33.3%) occurred in PLWH and controls, respectively, which corresponded to incidences of 68.31 in PLWH and 9.31 per 100,000 person-years in controls (P < 0.001). Lai et al [ 9 ] also looked for CVD in HIV patients and reported an incident density of 54.7, Standardized incidence rate (SIR) 3.01 (95% CI 2.39-3.73) for SCD in the subgroup analysis. All three articles agreed that the PLWH has a higher incidence of SCD than the general population, and it was statistically significant.…”

“…Alvi et al [ 7 ], Mongarden et al [ 10 ], Moyers et al [ 11 ], and Tseng et al [ 12 ] reported that their patients had a CD4+ T cell count of more than 50/cm. But Yen et al [ 8 ], Lai et al [ 9 ], and Raviglione et al [ 13 ] didn’t report CD4+ T cell count for their patients. Fifth, external validation was questionable in all of these studies, as these studies were in a specific location and lacked randomization.…”