Changes in atherosclerotic cardiovascular disease risk over time among people living with HIV

Abstract

Objective: To describe changes in atherosclerotic cardiovascular disease (ASCVD) risk over time among people living with HIV (PLHIV).

Methods: We used data from the TREAT Asia HIV Observational Database (TAHOD) and the Australian HIV Observational Database (AHOD). Five-year ASCVD risk was calculated using the D:A:D equation. Individuals were eligible for inclusion if they were aged ≥18 years, had started ART, had no previous history of ASCVD and had complete ASCVD risk factor data available within the first 5 years of ART initiation.

Results: A total of 3368 adults contributed data, 3221 were from TAHOD and 147 were from AHOD. The median age at ART initiation was 36 [IQR 31-43] years for TAHOD participants, and 42 [IQR 35-50] years for AHOD participants. Most TAHOD (70.4%) and AHOD (91.8%) participants were male. Overall, ASCVD risk increased from 0.84% (95% CI 0.81%-0.87%) at ART initiation to 1.34% (95% CI 1.29%-1.39%) after 5 years on ART. After adjusting for traditional and HIV-associated ASCVD risk factors, ASCVD risk increased at a similar rate among sub-populations defined by HIV exposure (heterosexuals, men who have sex with men, people who inject drugs), race/ethnicity (Caucasian and Asian) and nadir CD4 at ART initiation (<200 and ≥200 cells/mm3).

Conclusions: These findings emphasize the growing burden of ASCVD risk among PLHIV and the need to develop interventions that are effective across a broad range of HIV sub-populations.

Figure 1.

Predicted mean ASCVD score (%) in the first 5 years of ART initiation from the preferred piecewise model. The ASCVD scores were calculated from the D:A:D equation. The dot line represents the geometric mean value of the observed ASCVD scores at each follow-up time point. N represents the number of PLHIV at each follow-up time point.

Figure 2.

Adjusted mean ASCVD score (%) predictions in the first 5 years of ART by (a) mode of HIV acquisition, (b) race/ethnicity and (c) nadir CD4 count at ART initiation. The ASCVD scores were calculated from the D:A:D equation. Mean scores are reflective of the core reference categories: male sex, Asian ethnicity, heterosexual mode of HIV exposure, age >55 years, baseline nadir CD4 count ≥200 cells/mm³, BMI between 18.5–24.9 kg/m², non-smoker and no family history of ASCVD.