Cardiovascular events in delayed presentation of HIV : the prospective PISCIS cohort study
Martín-Iguacel, Raquel (Odense University Hospital (Dinamarca))
Vazquez-Friol, Mari Carmen (University Hospital Universitario de Ferrol)
Burgos, Joaquín (Hospital Universitari Vall d'Hebron)
Bruguera Riera, Andreu (Universitat Autònoma de Barcelona. Departament de Pediatria, Obstetrícia i Ginecologia i Medicina Preventiva i Salut Pública)
Reyes-Urueña, Juliana (Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT))
Moreno-Fornés, Sergio (Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública)
Aceitón, Jordi (Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT))
Díaz, Yesika (Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT))
Domingo, Pere (Institut d'Investigació Biomèdica Sant Pau)
Saumoy, Maria (Hospital Universitari de Bellvitge)
Knobel Freud, Hernando (Parc de Salut MAR de Barcelona)
Dalmau, David (Hospital Universitari MútuaTerrassa (Terrassa, Catalunya))
Borjabad, Beatriz (Consorci Sanitari Integral)
Johansen, Isik Somuncu (Odense University Hospital (Dinamarca))
Miro, Jose M. (Centro de Instituto de Salud Carlos III)
Casabona-Barbarà, Jordi (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Llibre, Josep M.. (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)

Date:	2023
Abstract:	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. 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. 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. 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.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Cardiovascular disease ; Cerebrovascular disease ; HIV ; Late HIV presentation ; Myocardial infarction
Published in:	Frontiers in Medicine, Vol. 10 (june 2023) , ISSN 2296-858X

DOI: 10.3389/fmed.2023.1182359
PMID: 37415770

14 p, 458.2 KB

The record appears in these collections:
Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut d'Investigació en Ciencies de la Salut Germans Trias i Pujol (IGTP)
Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut de Recerca Sant Pau
Articles > Research articles
Articles > Published articles