TY - JOUR
T1 - Cardiovascular events in delayed presentation of HIV
T2 - the prospective PISCIS cohort study
AU - Martín-Iguacel, Raquel
AU - Vazquez-Friol, Mari Carmen
AU - Burgos, Joaquin
AU - Bruguera, Andreu
AU - Reyes-Urueña, Juliana
AU - Moreno-Fornés, Sergio
AU - Aceitón, Jordi
AU - Díaz, Yesika
AU - Domingo, Pere
AU - Saumoy, Maria
AU - Knobel, Hernando
AU - Dalmau, David
AU - Borjabad, Beatriz
AU - Johansen, Isik Somuncu
AU - Miro, Jose M.
AU - Casabona, Jordi
AU - Llibre, Josep M.
AU - PISCIS study group
N1 - Funding Information:
The authors are grateful to the patients who participated in this cohort and our colleagues in the clinical departments for their continued contribution and dedication. The authors are grateful to PADRIS and the Programme for the Prevention, Control, and Care for HIV, Sexually Transmitted Diseases and Viral Hepatitis of the Ministry of Health of the Government of Catalonia for their support and the Danish AIDS Foundation, the University of Southern Denmark, the Region of Southern Denmark, Odense University Hospital, and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) for financial support.
Funding Information:
This work was supported by scholarships from the University of Southern Denmark, the Danish AIDS-foundation, and Public Regional Funds. JM received a personal 80:20 research grant from Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain, during 2017–23. The study was investigator-driven and thus independent of any pharmaceutical company. The funding sources were not involved in study design, data collection, analyses, report writing, or the decision to submit the paper.
PY - 2023
Y1 - 2023
N2 - Objectives: People with HIV (PWH) have a higher cardiovascular risk than the general population. It remains unclear, however, whether the risk of cardiovascular disease (CVD) is higher in late HIV presenters (LP; CD4 ≤ 350 cells/μL at HIV diagnosis) compared to PWH diagnosed early. We aimed to assess the rates of incident cardiovascular events (CVEs) following ART initiation among LP compared to non-LP. Methods: From the prospective, multicentre PISCIS cohort, we included all adult people with HIV (PWH) initiating antiretroviral therapy (ART) between 2005 and 2019 without prior CVE. Additional data were extracted from public health registries. The primary outcome was the incidence of first CVE (ischemic heart disease, congestive heart failure, cerebrovascular, or peripheral vascular disease). The secondary outcome was all-cause mortality after the first CVE. We used Poisson regression. Results: We included 3,317 PWH [26 589.1 person/years (PY)]: 1761 LP and 1556 non-LP. Overall, 163 (4.9%) experienced a CVE [IR 6.1/1000PY (95%CI: 5.3–7.1)]: 105 (6.0%) LP vs. 58 (3.7%) non-LP. No differences were observed in the multivariate analysis adjusting for age, transmission mode, comorbidities, and calendar time, regardless of CD4 at ART initiation [aIRR 0.92 (0.62–1.36) and 0.84 (0.56–1.26) in LP with CD4 count <200 and 200– ≤ 350 cells/μL, respectively, compared to non-LP]. Overall mortality was 8.5% in LP versus 2.3% in non-LP (p < 0.001). Mortality after the CVE was 31/163 (19.0%), with no differences between groups [aMRR 1.24 (0.45–3.44)]. Women vs. MSM and individuals with chronic lung and liver disease experienced particularly high mortality after the CVE [aMRR 5.89 (1.35–25.60), 5.06 (1.61–15.91), and 3.49 (1.08–11.26), respectively]. Sensitivity analyses including only PWH surviving the first 2 years yielded similar results. Conclusion: CVD remains a common cause of morbidity and mortality among PWH. LP without prior CVD did not exhibit an increased long-term risk of CVE compared with non-LP. Identifying traditional cardiovascular risk factors is essential for CVD risk reduction in this population.
AB - Objectives: People with HIV (PWH) have a higher cardiovascular risk than the general population. It remains unclear, however, whether the risk of cardiovascular disease (CVD) is higher in late HIV presenters (LP; CD4 ≤ 350 cells/μL at HIV diagnosis) compared to PWH diagnosed early. We aimed to assess the rates of incident cardiovascular events (CVEs) following ART initiation among LP compared to non-LP. Methods: From the prospective, multicentre PISCIS cohort, we included all adult people with HIV (PWH) initiating antiretroviral therapy (ART) between 2005 and 2019 without prior CVE. Additional data were extracted from public health registries. The primary outcome was the incidence of first CVE (ischemic heart disease, congestive heart failure, cerebrovascular, or peripheral vascular disease). The secondary outcome was all-cause mortality after the first CVE. We used Poisson regression. Results: We included 3,317 PWH [26 589.1 person/years (PY)]: 1761 LP and 1556 non-LP. Overall, 163 (4.9%) experienced a CVE [IR 6.1/1000PY (95%CI: 5.3–7.1)]: 105 (6.0%) LP vs. 58 (3.7%) non-LP. No differences were observed in the multivariate analysis adjusting for age, transmission mode, comorbidities, and calendar time, regardless of CD4 at ART initiation [aIRR 0.92 (0.62–1.36) and 0.84 (0.56–1.26) in LP with CD4 count <200 and 200– ≤ 350 cells/μL, respectively, compared to non-LP]. Overall mortality was 8.5% in LP versus 2.3% in non-LP (p < 0.001). Mortality after the CVE was 31/163 (19.0%), with no differences between groups [aMRR 1.24 (0.45–3.44)]. Women vs. MSM and individuals with chronic lung and liver disease experienced particularly high mortality after the CVE [aMRR 5.89 (1.35–25.60), 5.06 (1.61–15.91), and 3.49 (1.08–11.26), respectively]. Sensitivity analyses including only PWH surviving the first 2 years yielded similar results. Conclusion: CVD remains a common cause of morbidity and mortality among PWH. LP without prior CVD did not exhibit an increased long-term risk of CVE compared with non-LP. Identifying traditional cardiovascular risk factors is essential for CVD risk reduction in this population.
KW - cardiovascular disease
KW - cerebrovascular disease
KW - HIV
KW - late HIV presentation
KW - myocardial infarction
U2 - 10.3389/fmed.2023.1182359
DO - 10.3389/fmed.2023.1182359
M3 - Journal article
C2 - 37415770
AN - SCOPUS:85164816528
SN - 2296-858X
VL - 10
JO - Frontiers in Medicine
JF - Frontiers in Medicine
M1 - 1182359
ER -