Traditional and HIV-specific risk factors for cardiovascular morbidity and mortality among HIV-infected adults in Brazil: a retrospective cohort study

Abstract

BackgroundAntiretroviral therapy (ART) agents potentially associated with adverse metabolic profiles are commonly used in low- and middle-income countries. We assessed risk factors for cardiovascular disease (CVD)-related morbidity and mortality in a cohort of HIV-infected, ART-treated adults in Rio de Janeiro, Brazil.MethodsHospital records and mortality data between 2000–2010 were examined for incident CVD-related ICD-10 and Coding of Death in HIV diagnoses among adults ≥18 years old on ART, enrolled in an observational cohort. Poisson regression models assessed associations between demographic and clinical characteristics and ART agent or class on CVD event risk.ResultsOf 2960 eligible persons, 109 had a CVD event (89 hospitalizations, 20 deaths). Participants were 65 % male, 54 % white, and had median age of 37 and 4.6 years on ART. The median nadir CD4+ T lymphocyte count was 149 cells/mm3. The virologic suppression rate at the end of study follow-up was 60 %. In multivariable models, detectable HIV-1 RNA prior to the event, prior CVD, less time on ART, age ≥40 at study baseline, nadir CD4+ T lymphocyte count ≤50 cells/mm3, non-white race, male gender, and a history of hypertension were significantly associated with CVD event incidence (p < 0.05), in order of decreasing strength. In multivariate models, cumulative use of tenofovir, zidovudine, efavirenz and ritonavir-boosted atazanavir, darunavir and/or lopinavir were associated with decreased CVD event risk. Recent tenofovir and boosted atazanavir use were associated with decreased risk, while recent stavudine, nevirapine and unboosted nelfinavir and/or indinavir use were associated with increased CVD event risk.ConclusionsVirologic suppression and preservation of CD4+ T-lymphocyte counts were as important as traditional CVD risk factor burden in determining incident CVD event risk, emphasizing the overall benefit of ART on CVD risk and the need for metabolically-neutral first- and second-line ART in resource-limited settings.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1735-4) contains supplementary material, which is available to authorized users.

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

“…The rate for developing any CVD event in TAHOD was 2.2 per 1000 PY, while the rate for having a fatal CVD event was 0.36 per 1000 PY. Corroborating other studies , our findings confirm that traditional risk factors such as older age and the presence of high blood pressure, blood lipid abnormalities and high BMI are important risk factors for developing CVD. Those aged ≥ 51 years had 5.5 times the hazard compared with those aged < 40 years.…”

“…In our study, CVD was not significantly associated with male gender, high fasting plasma glucose, low HDL cholesterol or smoking. However, apart from smoking, all these factors did show a trend, albeit not statistically significant, of being unfavourable to cardiovascular health, as would be expected and as has been confirmed in previous studies .…”

Prevalência de excesso de peso, obesidade central e risco de comorbidades metabólicas em adultos com HIV/AIDS sem terapia antirretroviral

“…Nos últimos oito anos, no Brasil, foram notificados ao Ministério da Saúde 93.600 novos casos de pessoas infectadas pelo HIV totalizando 781.000 pessoas vivendo com HIV/AIDS (PVHA) e taxa de prevalência igual a 0,3% (2) . Incontestavelmente, a introdução dos antirretrovirais (ARV) no tratamento das PVHA, a partir da década de 90, aumentou exponencialmente a sobrevida destes indivíduos no Brasil e no mundo (3,4) . Em contrapartida à diminuição da mortalidade houve também o aumento de comorbidades associadas à infecção pelo HIV e uso dos ARV (2) .…”

“…O estado nutricional debilitado é um dos fatores que elevam o risco do PVHA desenvolver doenças crônicas (3,6) . Embora o ganho de peso beneficie o sistema imune e atenue o impacto de doenças oportunistas destes indivíduos, o aumento de gordura corporal, especialmente abdominal, pode ser fonte crônica de proteínas pró-inflamatórias que influenciam o curso da doença e o envelhecimento precoce (7,8) .…”

Atazanavir and Cardiovascular Risk Among Human Immunodeficiency Virus-Infected Patients: A Systematic Review

“…In an analysis of data from HIV-infected patients in the Veterans Health Administration Clinical Case Registry, exposure to ATV was not associated with an increased risk of CV events [41]. Moreover, in a retrospective, longitudinal study of patients with HIV in Brazil, the recent boosted ATV exposure was associated with a decreased risk of CV outcome events [42]. Finally, in a retrospective analysis of the Hawaii Aging with HIV CV Study, patients receiving ATV/r had a slower progression of cIMT over 2 years compared with those not receiving ATV/r (9 µm vs. 22 µm; p  < 0.001).…”