Evaluation of Cardiovascular Risk Factors Among Adults With Perinatally Acquired HIV

Abstract

Background: Despite successful ART, people with HIV are at increased risk of non-AIDS-related comorbidities, including cardiovascular and metabolic disease. Adults with perinatally acquired HIV (PaHIV) may face additional risks due to lifelong HIV-related inflammation and ART exposure. We explored cardiovascular and metabolic risk factors in a cohort of adults with PaHIV.

Methods: Case-note review of adults with PaHIV ≥18 years attending a UK specialist service. Hypertension was defined by World Health Organisation (WHO; ≥ 140/90 mmHg) and American Heart Association (AHA; ≥ 130/80 mmHg) guidelines. Standard lipid and blood pressure thresholds defined metabolic syndrome [triglycerides ≥1.7 mmol/L, high-density lipoprotein <1.04 mmol/L (men) and <1.29 mmol/L (women), BP ≥130/85 mmHg]. CVD risk was assessed using modifiable factors and Pathobiological Determinants of Atherosclerosis in Youth (PDAY) scores for coronary arteries (CAs) and abdominal aorta (AA).

Results: The cohort included 225 adults with PaHIV; median age 27 (IQR 23, 30) years, 55% female, and 86% Black ethnicity. Median CD4 count 634 (IQR 438, 815) cells/μL and ART duration 19 (IQR 13, 22) years. About 83% had HIV-1 RNA <50 copies/mL. Hypertension was identified in 9% and 21% of participants by WHO and AHA criteria, respectively. Metabolic syndrome was present in 3%. Elevated PDAY scores ≥1 were observed in 57% for CA and 51% for AA.

Conclusions: Despite viral suppression, over half the cohort had elevated PDAY scores, predictive of increased cardiovascular risk. WHO-defined hypertension rates were similar to an age-matched UK population; however, 1 in 5 were hypertensive by AHA criteria. Statin initiation guidelines may need adaptation for this population.

Keywords: PDAY score; cardiovascular risks; hypertension; metabolic syndrome; perinatally acquired HIV.

Figure 1.

Distribution of pathobiological determinants of atherosclerosis in youth (PDAY) risk scores. A, Distribution of coronary arteries (CA) PDAY risk scores. B, Distribution of abdominal aorta (AA) PDAY risk scores.