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Meta-Analysis
. 2017 May 11;12(5):e0176686.
doi: 10.1371/journal.pone.0176686. eCollection 2017.

HIV infection as vascular risk: A systematic review of the literature and meta-analysis

Jose Gutierrez  1 , Ana Letícia A Albuquerque  2 , Louise Falzon  3
Affiliations
Meta-Analysis

HIV infection as vascular risk: A systematic review of the literature and meta-analysis

Jose Gutierrez et al. PLoS One. .

Abstract

Importance: The vascular risk attributable to HIV infection is rising. The heterogeneity of the samples studied is an obstacle to understanding whether HIV is a vascular risk across geographic regions.

Objective: To test the hypothesis that HIV infection is a vascular risk factor, and that the risk conferred by HIV varies by geographical region.

Data sources: A systematic search of publications was carried out in seven electronic databases: PubMed, The Cochrane Library, EMBASE, Web of Science, LILACS, ClinicalTrials.gov, and WHO International Clinical Trials Registry Platform from inception to July 2015.

Study selection: We included longitudinal studies of HIV+ individuals and their risk of vascular outcomes of ≥ 50 HIV+ cases and excluded studies on biomarkers of vascular disease as well as clinical trials.

Data extraction and synthesis: Data was extracted by one of the authors and independently confirmed by the other two authors. We used incidence rate (IR), incidence risk ratio (IRR) and hazard ratio (HR) with their 95% confidence intervals as measures of risk.

Main outcome: All-death, myocardial infarction (MI), coronary heart disease (CHD), any stroke, ischemic stroke (IS) or intracranial hemorrhage (ICH).

Results: We screened 11,482 references for eligibility, and selected 117 for analysis. Forty-four cohorts represented 334,417 HIV+ individuals, 49% from the United States. Compared with their European counterparts, HIV+ individuals in the United States had higher IR of death (IRR 1.78, 1.69-1.88), MI (IRR 1.61, 1.29-2.01), CHD (IRR 2.27, 1.92-2.68), any stroke (IRR 1.94, 1.59-2.38), IS (IRR 1.56, 1.23-1.98), and ICH (IRR 4.03, 2.72-6.14). Compared with HIV- controls and independent of geographical region, HIV was a risk for death (HR 4.77, 4.55-5.00), MI (HR 1.60, 1.49-1.72), any CHD (HR 1.20, 1.15-1.25), any stroke (HR 1.82, 1.53-2.16), IS (HR 1.27, 1.15-1.39) and ICH (HR 2.20, 1.61-3.02). Use of antiretroviral therapy was a consistent risk for cardiac outcomes, while immunosuppression and unsuppressed viral load were consistent risks for cerebral outcomes.

Conclusions: HIV should be considered a vascular risk, with varying magnitudes across geographical and anatomical regions. We think that strategies to reduce the HIV-related vascular burden are urgent, and should incorporate the disparities noted here.

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Conflict of interest statement

Competing Interests: Jose Gutierrez, Ana Letícia A Albuquerque and Louise Falzon report no conflict of interest involving the work under consideration for publication. Jose Gutierrez has served as consultant for Prophase and received income for case litigation consulting fees outside the submitted work. Louise Falzon serves as a consultant on a project to develop Guidelines for the Rehabilitation and Chronic Disease Management of Adults with Moderate to Severe Traumatic Brain Injury with The Brain Injury Association of America (BIAA) and Mount Sinai Medical Center outside the submitted work. This does not alter our adherence to PLOS ONE policies on sharing data and materials. There are no patents, products in development or marketed products to declare.

Figures

Fig 1
Fig 1. Flow diagram of the systematic search.
Fig 2
Fig 2. Risk of death in HIV+ individuals vs. HIV- controls.
Red squares represent the point estimate for HIV-related vascular risk by study, and the size of each red square represents the weight of each study in the average effect size. Horizontal lines across red squares represent the 95% confidence intervals for the point estimate. The diamonds represent the weighted average point estimate.
Fig 3
Fig 3. Risk of myocardial infarction in HIV+ individuals vs. HIV- controls.
Red squares represent the point estimate for HIV-related vascular risk by study, and the size of each red square represents the weight of each study in the average effect size. Horizontal lines across red squares represent the 95% confidence intervals for the point estimate. The diamonds represent the weighted average point estimate.
Fig 4
Fig 4. Risk of any coronary artery disease in HIV+ individuals vs. HIV- controls.
Red squares represent the point estimate for HIV-related vascular risk by study, and the size of each red square represents the weight of each study in the average effect size. Horizontal lines across red squares represent the 95% confidence intervals for the point estimate. The diamonds represent the weighted average point estimate.
Fig 5
Fig 5. Risk of cerebrovascular events in HIV+ individuals vs. HIV- controls.
Red squares represent the point estimate for HIV-related vascular risk by study, and the size of each red square represents the weight of each study in the average effect size. Horizontal lines across red squares represent the 95% confidence intervals for the point estimate. The diamonds represent the weighted average point estimate.
See this image and copyright information in PMC

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