People living with HIV have a 60% higher risk of having a heart attack, compared to their non-HIV carriers, according to research presented in the
Conference on Retroviruses and Opportunistic Infections (CROI 2022)which has also seen that the situation worsens with the passage of time.
Cardiovascular disease is the leading cause of death in the world. According to the study Global Burden of Atherosclerotic Cardiovascular Disease in
People Living With HIVHIV infection is associated with a risk of cardiovascular disease that is comparable to other high-risk groups, such as diabetes (60 cases per 10,000 people per year).
Previous research has shown that people living with HIV have a higher risk of cardiovascular problems than people without HIV, likely attributable to higher rates of traditional risk factors such as high blood pressure and smoking.
But inflammation due to chronic HIV, abnormalities of the immune system, and antiretroviral treatment can also play a role.
In addition, there is the paradox that because antiretroviral therapy has revolutionized the prognosis of people living with HIV and has drastically increased their survival, there are more and more concomitant diseases that are becoming relevant, such as cardiovascular health , one of the main causes of morbidity and mortality in the HIV-infected population, especially in developed countries.
Silverberg’s team looked at changes over time in heart attack rates among HIV-positive and HIV-negative members of two large health systems that had similar cardiovascular risk profiles. They compared two different stages: 2005 to 2009 and 2010 to 2017.
The analysis included 9,401 seropositive adults. Each of them was matched with three or four HIV-negative people (for a total of 29,418) with similar demographic characteristics and cardiovascular similarity as assessed by the Framingham scale – a measure that incorporates blood pressure, cholesterol levels or mass index body, diabetes and smoking.
Nearly 90% of study participants were men, reflecting the HIV-positive populations in San Francisco and Boston, and the average age was approximately 44 years. About half were white, regarding 18% were black, and the rest were from other racial/ethnic groups. About a quarter smoked, a quarter took medication for high blood pressure, and 6% had diabetes.
The characteristics of the seropositive group changed over time. During the first stage, 76% were on antiretroviral treatment, 61% had viral suppression (less than 400 copies), and the median CD4 count was 470. In the second, from 2010 to 2017, 88% were taking antiretrovirals, 77 % had viral suppression and the median CD4 count was 587.
During 2005 to 2009, the five-year cumulative incidence of myocardial infarction was the same in the seropositive and seronegative groups, at 1.1% each. But at the later stage, the rates diverged.
They found that the five-year rate of myocardial infarction increased to 1.2% in the HIV-positive group while it fell to 0.9% in the HIV-negative group, a statistically significant difference. After adjusting for demographics and risk factors, people with HIV had a 60% increased risk of heart attack compared to the HIV-negative group during 2010 to 2017.
A similar pattern was seen when the researchers looked at 10 years of follow-up data and when they stratified the results by sex, although there were too few women to draw firm conclusions.
The researchers noted that the difference in risk of myocardial infarction in the later period appeared to be driven largely by a reduction in risk for the HIV-negative group rather than an increase in risk for the HIV-positive group.
The study suggests that HIV-specific factors, such as living with HIV longer and using newer antiretrovirals, may have prevented people with HIV from achieving the same improvement as their seronegative counterparts.
These findings, Silverberg concludes, point to the need for continued monitoring of cardiovascular disease trends and more prevention interventions for people living with HIV.
