Relative risk of cardiovascular disease among people living with HIV: a systematic review and meta‐analysis

Abstract

ObjectivesThe aim of this study was to estimate the relative risk of cardiovascular disease (CVD) among people living with HIV (PLHIV) compared with the HIV-uninfected population. MethodsWe conducted a systematic review and meta-analysis of studies from the peer-reviewed literature. We searched the Medline database for relevant journal articles published before August 2010. Eligible studies were observational and randomized controlled trials, reporting CVD, defined as myocardial infarction (MI), ischaemic heart disease, cardiovascular and cerebrovascular events or coronary heart disease among HIV-positive adults. Pooled relative risks were calculated for various groupings, including different classes of antiretroviral therapy (ART). ResultsThe relative risk of CVD was 1.61 [95% confidence interval (CI) 1.43-1.81] among PLHIV without ART compared with HIV-uninfected people. The relative risk of CVD was 2.00 (95% CI 1.70-2.37) among PLHIV on ART compared with HIV-uninfected people and 1.52 (95% CI 1.35-1.70) compared with treatment-naïve PLHIV. We estimate the relative risk of CVD associated with protease inhibitor (PI)-, nucleoside reverse transcriptase inhibitor-and nonnucleoside reverse transcriptase inhibitor-based ART to be 1.11 (95% CI 1.05-1.17), 1.05 (95% CI 1.01-1.10) and 1.04 (95% CI 0.99-1.09) per year of exposure, respectively. Not all ART was associated with increased risk; specifically, lopinavir/ritonavir and abacavir were associated with the greater risk and the relative risk of MI for PI-based versus non-PI-based ART was 1.41 (95% CI 1.20-1.65). ConclusionPLHIV are at increased risk of cardiovascular disease. Although effective in prolonging survival, ART (in particular PI-based regimens) is related to further increased risk of CVD events among people at highest initial absolute risk of cardiovascular disease.

Paediatric European Network for Treatment of AIDS (PENTA) guidelines for treatment of paediatric HIV‐1 infection 2015: optimizing health in preparation for adult life

“…A number of studies have documented increased rates of cardiovascular and cerebrovascular disease in HIV‐infected adults, which appear to be multifactorial and relate both to HIV disease itself and ART, with the greater risk associated with PIs and ABC 104, 105. Several mechanisms have been postulated, including metabolic and lipid derangement (especially related to PI), insulin resistance, direct vascular injury and increased inflammation 106.…”

Hepatitis C – Human Immunodeficiency Virus Coinfection and the Risk of Cerebro-Cardiovascular Diseases: Is There Enough Evidence to Draw Conclusion and Establish Guideline?

“…Recent meta-anaylsis by Islam et al [1], concluded that HIV infection increases the risk of cardiovascular diseases (CVD). They found the relative risk (RR) of CVD among people living with HIV (PLHIV) was 1.61 (95% CI 1.43-1.81).…”

“…They found the relative risk (RR) of CVD among people living with HIV (PLHIV) was 1.61 (95% CI 1.43-1.81). Despite the introduction of antiretroviral therapy (ART) which increase survival of PLHIV, ART itself increase the risk of CVD (RR 2,00 95% CI 1,70-2,37) [1]. Management of HIV has shifted from treating the disease to managing complication and chronic condition such as atherosclerosis [2].…”

Use of HMG-CoA Reductase Inhibitors in the HIV Population: Implications for Individualized Treatment Selection

“…5 The relative risk of developing CVD in HIV patients has been estimated to be 61% higher than in non-HIV patients. 6 The manifestation of coronary atherosclerosis in HIV patients is hypothesized to be due to a higher prevalence of conventional risk factors (smoking, dyslipidemia, hypertension, and insulin abnormalities); emerging risk factors (chronic follow-up time of 6.62 years. The association of cumulative exposure to any statin and occurrences of death, CVD, malignancies, and fragility fractures was assessed.…”