. 2025 Jan 13;12(2):ofaf016.

doi: 10.1093/ofid/ofaf016. eCollection 2025 Feb.

Viremia Does Not Independently Predict Cardiovascular Disease in People With HIV: A RESPOND Cohort Study

Olof Elvstam^{1

2}, Lene Ryom^{3

4

5}, Bastian Neesgaard³, Luba Tau⁶, Huldrych F Günthard^{7

8}, Robert Zangerle⁹, Jörg Janne Vehreschild¹⁰, Ferdinand Wit¹¹, Anders Sönnerborg^{12

13}, Helen Kovari¹⁴, Akaki Abutidze¹⁵, Kathy Petoumenos¹⁶, Nadine Jaschinski³, Sean Hosein¹⁷, Johannes Bogner¹⁸, Katharina Grabmeier-Pfistershammer¹⁹, Harmony Garges²⁰, Jim Rooney²¹, Lital Young²², Matthew Law²³, Ole Kirk^{3

4

24}; RESPOND Study Group

Collaborators, Affiliations

Collaborators

RESPOND Study Group:
F Wit, M van der Valk, M Hillebregt, K Petoumenos, M Law, J Hutchinson, D Rupasinghe, W Min Han, R Zangerle, H Appoyer, J Vera, A Clarke, B Broster, L Barbour, D Carney, L Greenland, R Coughlan, S De Wit, M Delforge, J Begovac, G Wandeler, C Stephan, M Bucht, N Chkhartishvili, O Chokoshvili, A d'Arminio Monforte, A Rodano, A Tavelli, C Mussini, V Borghi, M Menozzi, A Cervo, C Pradier, E Fontas, K Dollet, C Caissotti, J Casabona, J M Miro, J M Llibre, A Riera, J Reyes-Urueña, F Burns, C Smith, F Lampe, C Chaloner, A Castagna, A Lazzarin, A Poli, R Lolatto, A Sönnerborg, C Carlander, P Nowak, J Vesterbacka, L Mattsson, D Carrick, K Stigsäter, H Günthard, B Ledergerber, H Bucher, K Kusejko, J C Wasmuth, J Rockstroh, J J Vehreschild, G Fätkenheuer, M Scherer, G Sauer, L Ryom, M Law, F Bognar, R Campo, S De Wit, H Garges, H Günthard, C Mussini, J Lundgren, J Rooney, V Vannappagari, G Wandeler, L Young, R Zangerle, J Lundgren, H Günthard, J Begovac, F Burns, A Castagna, R Campo, N Chkhartishvili, A D'Arminio Monforte, N Dedes, M Dunbar, H Garges, J Kowalska, M Law, C Mussini, C Necsoi, L Peters, K Petoumenos, C Pradier, D Raben, J Rockstroh, J Rooney, L Ryom, A Sönnerborg, V Vannappagari, C Lehmann, A Volny-Anne, J C Wasmuth, E D Williams, F Wit, L Young, R Zangerle, L Ryom, B Neesgaard, L Greenberg, N Jaschinski, A Timiryasova, L Bansi-Matharu, D Raben, L Peters, E Tusch, W Bannister, A Roen, D Byonanebye, O Fursa, A Pelchen-Matthews, J Reekie, V Svedhem-Johansson, M Van der Valk, F Wit, K Grabmeier-Pfistershammer, R Zangerle, J Hoy, M Bloch, D Braun, A Calmy, G Schüttfort, M Youle, S De Wit, C Mussini, S Zona, A Castagna, A Antinori, N Chkhartishvili, N Bolokadze, E Fontas, K Dollet, C Pradier, J M Miro, J M Llibre, J J Vehreschild, C Schwarze-Zander, J C Wasmuth, J Rockstroh, K Petoumenos, J Hutchinson, M Law, J Begovac, C Duvivier, G Dragovic, R Radoi, C Oprea, M Vasylyev, J Kowalska, R Matulionyte, V Mulabdic, G Marchetti, E Kuzovatova, N Coppola, I Aho, S Martini, H Bucher, A Harxhi, T Wæhre, A Pharris, A Vassilenko, G Fätkenheuer, J Bogner, A Maagaard, E Jablonowska, D Elbirt, G Marrone, C Leen, C Wyen, L Dahlerup Rasmussen, C Hatleberg, C Carlander, M Kundro, F Burns, O Elvstam, N Dedes, E Dixon Williams, J Gallant, C Cohen, M Dunbar, A Marongiu, V Vannappagari, H Garges, R Campo, L Young, A Abutidze, I Aho, J Begovac, L Dahlerup Rasmussen, R Campo, M Dunbar, A Ekström, O Elvstam, O Fursa, C Hatleberg, J Gallant, H Garges, J Gruber, H Günthard, J Hosein, J Hoy, O Kirk, M Law, N Jaschinski, A Marongiu, B Neesgaard, L Peters, K Petoumenos, J Rooney, L Ryom, A Sönnerborg, A Timiryasova, M Van der Valk, V Vannappagari, J Vehreschild, A Weibull Wärnberg, F Wit, X Xu, L Young, R Zangerle, P Meidahl Petersen, M Bower, K Lærum Sibilitz, A Volny-Anne, N Dedes, L Mendão, N Jaschinski, A Timiryasova, B Neesgaard, O Fursa, O Valdenmaier, M Gardizi, T W Elsing, L Ramesh Kumar, L Ryom, J F Larsen, D Raben, L Peters, L Greenberg, K Petoumenos, W Min Han, E Tusch, W Bannister, J Reekie

Affiliations

¹ Department of Translational Medicine, Lund University, Malmö, Sweden.
² Department of Infectious Diseases, Växjö Central Hospital, Växjö, Sweden.
³ CHIP, Centre of Excellence for Health, Immunity and Infections, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
⁴ Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
⁵ Department of Infectious Diseases 144, Hvidovre University Hospital, Copenhagen, Denmark.
⁶ Tel Aviv Sourasky Medical Center, Faculty of Medicine Tel-Aviv University, Tel-Aviv, Israel.
⁷ Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.
⁸ Institute of Medical Virology, University of Zurich, Zurich, Switzerland.
⁹ Department of Dermatology, Venereology and Allergology, Medical University of Innsbruck, University Hospital, Innsbruck, Austria.
¹⁰ Institute for Digital Medicine and Clinical Data Sciences, Goethe University Frankfurt, Frankfurt am Main, Germany.
¹¹ AIDS Therapy Evaluation in the Netherlands (ATHENA) cohort, HIV Monitoring Foundation, Amsterdam, The Netherlands.
¹² Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
¹³ Division of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.
¹⁴ Center for Infectious Diseases, Klinik im Park, Zürich, Switzerland.
¹⁵ Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia.
¹⁶ The Australian HIV Observational Database (AHOD), The Kirby Institute, UNSW Sydney, New South Wales, Australia.
¹⁷ European AIDS Treatment Group (EATG), Brussels, Belgium.
¹⁸ Department of Medicine IV, University Hospital, LMU Munich, Munich, Germany.
¹⁹ Universitätsklinik für Dermatologie, Medizinische Universität Wien, Vienna, Austria.
²⁰ ViiV Healthcare, Research Triangle Park, Durham, North Carolina, USA.
²¹ Gilead Science, Foster City, California, USA.
²² Merck Sharp & Dohme, Rahway, New Jersey, USA.
²³ Biostatistics and Databases Program, Kirby Institute, UNSW Sydney, New South Wales, Australia.
²⁴ Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.

PMID: 39896984
PMCID: PMC11786055
DOI: 10.1093/ofid/ofaf016

Viremia Does Not Independently Predict Cardiovascular Disease in People With HIV: A RESPOND Cohort Study

Olof Elvstam et al. Open Forum Infect Dis. 2025.

. 2025 Jan 13;12(2):ofaf016.

doi: 10.1093/ofid/ofaf016. eCollection 2025 Feb.

Authors

Collaborators

RESPOND Study Group:
F Wit, M van der Valk, M Hillebregt, K Petoumenos, M Law, J Hutchinson, D Rupasinghe, W Min Han, R Zangerle, H Appoyer, J Vera, A Clarke, B Broster, L Barbour, D Carney, L Greenland, R Coughlan, S De Wit, M Delforge, J Begovac, G Wandeler, C Stephan, M Bucht, N Chkhartishvili, O Chokoshvili, A d'Arminio Monforte, A Rodano, A Tavelli, C Mussini, V Borghi, M Menozzi, A Cervo, C Pradier, E Fontas, K Dollet, C Caissotti, J Casabona, J M Miro, J M Llibre, A Riera, J Reyes-Urueña, F Burns, C Smith, F Lampe, C Chaloner, A Castagna, A Lazzarin, A Poli, R Lolatto, A Sönnerborg, C Carlander, P Nowak, J Vesterbacka, L Mattsson, D Carrick, K Stigsäter, H Günthard, B Ledergerber, H Bucher, K Kusejko, J C Wasmuth, J Rockstroh, J J Vehreschild, G Fätkenheuer, M Scherer, G Sauer, L Ryom, M Law, F Bognar, R Campo, S De Wit, H Garges, H Günthard, C Mussini, J Lundgren, J Rooney, V Vannappagari, G Wandeler, L Young, R Zangerle, J Lundgren, H Günthard, J Begovac, F Burns, A Castagna, R Campo, N Chkhartishvili, A D'Arminio Monforte, N Dedes, M Dunbar, H Garges, J Kowalska, M Law, C Mussini, C Necsoi, L Peters, K Petoumenos, C Pradier, D Raben, J Rockstroh, J Rooney, L Ryom, A Sönnerborg, V Vannappagari, C Lehmann, A Volny-Anne, J C Wasmuth, E D Williams, F Wit, L Young, R Zangerle, L Ryom, B Neesgaard, L Greenberg, N Jaschinski, A Timiryasova, L Bansi-Matharu, D Raben, L Peters, E Tusch, W Bannister, A Roen, D Byonanebye, O Fursa, A Pelchen-Matthews, J Reekie, V Svedhem-Johansson, M Van der Valk, F Wit, K Grabmeier-Pfistershammer, R Zangerle, J Hoy, M Bloch, D Braun, A Calmy, G Schüttfort, M Youle, S De Wit, C Mussini, S Zona, A Castagna, A Antinori, N Chkhartishvili, N Bolokadze, E Fontas, K Dollet, C Pradier, J M Miro, J M Llibre, J J Vehreschild, C Schwarze-Zander, J C Wasmuth, J Rockstroh, K Petoumenos, J Hutchinson, M Law, J Begovac, C Duvivier, G Dragovic, R Radoi, C Oprea, M Vasylyev, J Kowalska, R Matulionyte, V Mulabdic, G Marchetti, E Kuzovatova, N Coppola, I Aho, S Martini, H Bucher, A Harxhi, T Wæhre, A Pharris, A Vassilenko, G Fätkenheuer, J Bogner, A Maagaard, E Jablonowska, D Elbirt, G Marrone, C Leen, C Wyen, L Dahlerup Rasmussen, C Hatleberg, C Carlander, M Kundro, F Burns, O Elvstam, N Dedes, E Dixon Williams, J Gallant, C Cohen, M Dunbar, A Marongiu, V Vannappagari, H Garges, R Campo, L Young, A Abutidze, I Aho, J Begovac, L Dahlerup Rasmussen, R Campo, M Dunbar, A Ekström, O Elvstam, O Fursa, C Hatleberg, J Gallant, H Garges, J Gruber, H Günthard, J Hosein, J Hoy, O Kirk, M Law, N Jaschinski, A Marongiu, B Neesgaard, L Peters, K Petoumenos, J Rooney, L Ryom, A Sönnerborg, A Timiryasova, M Van der Valk, V Vannappagari, J Vehreschild, A Weibull Wärnberg, F Wit, X Xu, L Young, R Zangerle, P Meidahl Petersen, M Bower, K Lærum Sibilitz, A Volny-Anne, N Dedes, L Mendão, N Jaschinski, A Timiryasova, B Neesgaard, O Fursa, O Valdenmaier, M Gardizi, T W Elsing, L Ramesh Kumar, L Ryom, J F Larsen, D Raben, L Peters, L Greenberg, K Petoumenos, W Min Han, E Tusch, W Bannister, J Reekie

Affiliations

¹ Department of Translational Medicine, Lund University, Malmö, Sweden.
² Department of Infectious Diseases, Växjö Central Hospital, Växjö, Sweden.
³ CHIP, Centre of Excellence for Health, Immunity and Infections, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
⁴ Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
⁵ Department of Infectious Diseases 144, Hvidovre University Hospital, Copenhagen, Denmark.
⁶ Tel Aviv Sourasky Medical Center, Faculty of Medicine Tel-Aviv University, Tel-Aviv, Israel.
⁷ Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.
⁸ Institute of Medical Virology, University of Zurich, Zurich, Switzerland.
⁹ Department of Dermatology, Venereology and Allergology, Medical University of Innsbruck, University Hospital, Innsbruck, Austria.
¹⁰ Institute for Digital Medicine and Clinical Data Sciences, Goethe University Frankfurt, Frankfurt am Main, Germany.
¹¹ AIDS Therapy Evaluation in the Netherlands (ATHENA) cohort, HIV Monitoring Foundation, Amsterdam, The Netherlands.
¹² Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
¹³ Division of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.
¹⁴ Center for Infectious Diseases, Klinik im Park, Zürich, Switzerland.
¹⁵ Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia.
¹⁶ The Australian HIV Observational Database (AHOD), The Kirby Institute, UNSW Sydney, New South Wales, Australia.
¹⁷ European AIDS Treatment Group (EATG), Brussels, Belgium.
¹⁸ Department of Medicine IV, University Hospital, LMU Munich, Munich, Germany.
¹⁹ Universitätsklinik für Dermatologie, Medizinische Universität Wien, Vienna, Austria.
²⁰ ViiV Healthcare, Research Triangle Park, Durham, North Carolina, USA.
²¹ Gilead Science, Foster City, California, USA.
²² Merck Sharp & Dohme, Rahway, New Jersey, USA.
²³ Biostatistics and Databases Program, Kirby Institute, UNSW Sydney, New South Wales, Australia.
²⁴ Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.

PMID: 39896984
PMCID: PMC11786055
DOI: 10.1093/ofid/ofaf016

Abstract

Background: HIV viremia has been considered a cardiovascular disease (CVD) risk factor, but many studies have had insufficient data on potential confounders. We explored the association between viremia and CVD after adjusting for established risk factors and analyzed whether consideration of viremia would improve CVD prediction.

Methods: Adults from RESPOND were followed from the first date with available data until the first of rigorously defined CVD, loss to follow-up, death, or administrative censoring. We first analyzed the associations between 6 measures of viremia (time-updated, before antiretroviral therapy [ART], viremia category, and measures of cumulative viremia) and CVD after adjusting for the variables in the D:A:D CVD score (age, sex/gender, smoking, family history, diabetes, recent abacavir, CD4 count, blood pressure, cholesterol, high-density lipoprotein, cumulative use of stavudine, didanosine, indinavir, lopinavir, and darunavir). We subsequently compared predictive performance with and without viremia in 5-fold internal cross-validation.

Results: A total of 547 events were observed in 17 497 persons (median follow-up, 6.8 years). Although some viremia variables were associated with CVD in univariable analyses, there were no statistically significant associations after adjusting for potential confounders, neither for measures of current viral load, pre-ART viral load, highest viremia category during ART, nor cumulative viremia (modeled both as total cumulative viremia, cumulative viremia during ART, and recent cumulative viremia). Consistently, none of the viremia variables improved prediction capacity.

Conclusions: In this large international cohort, HIV viremia was not associated with CVD when adjusting for established risk factors. Our results did not show viremia to be predictive of CVD among people with HIV.

Keywords: HIV viremia; cardiovascular diseases; myocardial infarction; prediction; stroke.

PubMed Disclaimer

Conflict of interest statement

Potential conflicts of interest. O.E. reports speaker fee from Gilead Sciences, unrelated to this work. H.F.G. reports honoraria for data and safety monitoring board or advisory board membership from Merck, Gilead Sciences, ViiV Healthcare, GSK, Janssen, Johnson & Johnson, and Novartis; a travel grant from Gilead Sciences; unrestricted research grants from Gilead Sciences and ViiV; grants or contracts paid to institution from the Swiss National Science Foundation, Swiss HIV Cohort Study, National Institute of Health; and an unrestricted research grant from Gilead Sciences, Bill and Melinda Gates Foundation and Yvonne Jacob Foundation. F.W. reports consultancy work for ViiV healthcare for which his institution received payment. H.K. reports speaker fees from Gilead Sciences and ViiV, unrelated to this work. S.H. reports advisory board membership from ViiV Healthcare. O.K. reports honoraria for presentations at meetings supported by Merck, unconditional research grants from Gilead and travel support from Gilead and ViiV. H.G., J.R., and L.Y. are employees of ViiV Healthcare, Gilead Sciences, and MSD, respectively. The remaining authors report no conflicts of interest.

Figures

**Figure 1.**
Exclusion flowchart. Abbreviation: HDL, high-density lipoprotein.

**Figure 2.**
Associations between viremia variables and CVD events. Gray bars represent unadjusted estimates and black bars are adjusted for age, sex/gender, smoking, family history of cardiovascular diseases, diabetes, recent abacavir exposure, cumulative exposure to indinavir, ritonavir boosted lopinavir, or darunavir and stavudine or didanosine, respectively, CD4 count, systolic blood pressure, total cholesterol, and high-density lipoprotein (all time-updated) and stratified by SCORE2 risk stratum. Abbreviations: ART, antiretroviral therapy; CVD, cardiovascular disease; VL, viral load.

See this image and copyright information in PMC

References

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Viremia Does Not Independently Predict Cardiovascular Disease in People With HIV: A RESPOND Cohort Study

Collaborators

Affiliations

Viremia Does Not Independently Predict Cardiovascular Disease in People With HIV: A RESPOND Cohort Study

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

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References

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