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. 2023 Jun 21:10:1182359.
doi: 10.3389/fmed.2023.1182359. eCollection 2023.

Cardiovascular events in delayed presentation of HIV: the prospective PISCIS cohort study

Raquel Martín-Iguacel #  1   2 , Mari Carmen Vazquez-Friol #  3 , Joaquin Burgos  4 , Andreu Bruguera  1   5   6 , Juliana Reyes-Urueña  1 , Sergio Moreno-Fornés  1   5 , Jordi Aceitón  1 , Yesika Díaz  1 , Pere Domingo  7 , Maria Saumoy  8 , Hernando Knobel  9 , David Dalmau  10 , Beatriz Borjabad  11 , Isik Somuncu Johansen  2 , Jose M Miro  12   13 , Jordi Casabona  1   5   6   14 , Josep M Llibre  15   16
Affiliations

Cardiovascular events in delayed presentation of HIV: the prospective PISCIS cohort study

Raquel Martín-Iguacel et al. Front Med (Lausanne). .

Abstract

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.

Keywords: HIV; cardiovascular disease; cerebrovascular disease; late HIV presentation; myocardial infarction.

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Conflict of interest statement

JM has received consulting honoraria and/or research grants from AbbVie, Angelini, Contrafect, Cubist, Genentech, Gilead Sciences, Jansen, Lysovant, Medtronic, MSD, Novartis, Pfizer, and ViiV Healthcare, outside the submitted study. JL has received honoraria and/or research grants from ViiV Healthcare, Gilead Sciences, and Janssen-Cilag. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of cohort construction.
Figure 2
Figure 2
Kaplan–Meier curves of time to cardiovascular events. (A) Incident cardiovascular events by CD4 cell count at ART initiation. (B) Incident cardiovascular events by CD4 cell count 2 years after ART initiation.
See this image and copyright information in PMC

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