Factors associated with the development of fatal or nonfatal cardiovascular disease (CVD) events in a cohort of people with HIV from multiple Asian countries were older age and treatable risk factors such as high blood pressure, triglycerides, total cholesterol, and body mass index, according to data published in HIV Medicine.
As the population of people with HIV ages, CVD is a growing cause of death and morbidity. Patient data from Therapeutics, Research, Education and AIDS Training in Asia (TREAT Asia) HIV Observational Database (TAHOD) from 2003 to 2017 were used to identify 8069 patients receiving antiretroviral therapy (ART) with >1 day of follow-up. Data from these patients were used to investigate CVD-related and other causes of death and the associated factors.
The median follow-up time of the patient cohort was 7.3 years (interquartile range, 4.4-10.7 years). Of these 8069 patients, 378 died (incidence rate, 6.2 per 1000 person years), including 22 CVD-related deaths (incidence rate, 0.36 per 1000 person years). Older age (subhazard ratio [sHR], 2.21 [95% CI, 1.36-3.58] for age 41-50 years; sHR 5.52 [95% CI, 3.43-8.91] for age ≥51 years compared with age <40 years), high blood pressure (sHR, 1.62; 95% CI, 1.04-2.52), high total cholesterol (sHR, 1.89; 95% CI, 1.27-2.82), high triglycerides (sHR, 1.55; 95% CI, 1.02-2.37), and high body mass index (sHR, 1.66; 95% CI, 1.12-2.46) were all significantly associated with any CVD event (incidence rate, 2.2 per 1000 person years). Investigators also found that CVD crude incidence rates were lower in the lower middle- and upper middle-income countries, as well as in those with a later ART initiation period.
The study was unable to discern the differences in risk factors for fatal vs nonfatal CVD because of small sample size in the cohort. Investigators also believed there may have been an underdiagnosis of CVD events, as a result of factors involved with lower resource settings, such as limited accessibility of screening tools and a tendency for marginalized groups to not seek care. In addition, the influence of specific antiretroviral drugs and inflammatory markers associated with CVD could not be evaluated. Nor was the effect of comedications or treatments received outside of the observation period accounted for. Finally, investigators noted that there was a relatively high proportion of missing data regarding CVD risk factors, meaning some of the effect was undetected.
Investigators concluded that the primary cause of mortality for those living with HIV in the Asia-Pacific regions remains HIV and, to a lesser extent, noncommunicable disease, including CVD. The fact that most risk factors were modifiable was encouraging to investigators, “[i]t is reassuring that many of the risk factors we identified are of a modifiable nature and can be targeted with interventions.” However, these results highlight the importance of regular monitoring and treatment of CVD risk profiles. These findings were similar to those found in other regions, noted investigators, revealing “lessons may be learned from efforts to improve CVD risk profiles that have proved successful in other settings.”
Bijker R, Jiamsakul A, Uy E, et al. Cardiovascular disease-related mortality and factors associated with cardiovascular events in the TREAT Asia HIV Observational Database (TAHOD) [published online January 8, 2019]. HIV Med. doi: 10.1111/hiv.12687