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Incidence of atherosclerotic cardiovascular disease among HIV patients receiving dialysis
Pooja C Oberai1, Darshan Dalal, Lin Zhang
1Department of Pediatrics, Johns Hopkins University, Baltimore, MD, USA.
Insights
Patients with HIV and end-stage renal disease initiating dialysis after 1997 face a higher risk of atherosclerotic cardiovascular disease (ASCVD). This increased ASCVD risk highlights the need for proactive management in this vulnerable population.
Area of Science:
- Nephrology
- Cardiology
- Infectious Diseases
Background:
- Atherosclerotic cardiovascular disease (ASCVD) incidence is rising in individuals with human immunodeficiency virus (HIV).
- The impact of this trend on patients with HIV and end-stage renal disease (ESRD) remains unclear, despite improved survival rates since 1997.
- ESRD patients with HIV face unique challenges due to combined conditions and treatments.
Purpose of the Study:
- To investigate the incidence and risk of ASCVD events in patients with HIV and ESRD.
- To compare ASCVD risk between patients initiating dialysis before and after 1997.
- To understand the long-term cardiovascular implications for HIV-positive ESRD patients.
Main Methods:
- A population-based study utilizing the US Renal Data System (USRDS) from 1987 to 2001.
- Inclusion of 8,312 patients diagnosed with HIV and ESRD.
- Stratification of ASCVD event incidence based on dialysis initiation date (pre- vs. post-1997).
Main Results:
- Patients initiating dialysis after 1997 showed significantly higher cumulative incidences of ASCVD at 12, 24, 36, and 48 months compared to those initiating before 1997.
- The adjusted hazard ratio for developing ASCVD was 1.57 (95% CI, 1.29 to 1.92) for patients initiating dialysis after 1997.
- Demographics and ASCVD risk factors were adjusted for in the analysis.
Conclusions:
- There is a demonstrably increased risk of ASCVD in HIV-positive ESRD patients who began dialysis therapy after 1997.
- This elevated risk may be linked to long-term effects of multidrug regimens and increased survival leading to prolonged exposure to cardiovascular risk factors.
- Findings underscore the critical need for enhanced cardiovascular risk management strategies in this growing patient cohort.
Background:
Atherosclerotic cardiovascular disease (ASCVD) is increasing in incidence in persons with human immunodeficiency virus (HIV). It is not known whether the morbidity and mortality rate of ASCVD is similarly increasing among patients with HIV end-stage renal disease (ESRD), who are living longer since the initiation of newer therapeutic regimens in 1997.
Methods:
We conducted a population-based study of 8,312 HIV ESRD patients enrolled in the US Renal Data System from 1987 to 2001. We determined the incidence of fatal and nonfatal ASCVD events stratified by date of dialysis therapy initiation.
Results:
There were 3,112 HIV ESRD patients (77.9% men; mean age, 39.6 +/- 9.6 years) who initiated dialysis therapy before 1997 and 2,371 patients (71.5% men; mean age, 41.3 +/- 9.7 years) who initiated dialysis therapy after 1997. Cumulative incidences of ASCVD for those initiating dialysis therapy before 1997 compared with after 1997 were 10.6% versus 13.5% at 12 months, 18.8% versus 27.6% at 24 months, 26.2% versus 42.4% at 36 months, and 33.7% versus 65.9% at 48 months (P < 0.0001 by log rank). Those who initiated dialysis therapy after 1997 had a greater risk for developing ASCVD (adjusted hazard ratio, 1.57; 95% confidence interval, 1.29 to 1.92) than those who initiated dialysis therapy before 1997 after adjusting for demographics and ASCVD risk factors.
Conclusion:
There is an increased risk for ASCVD in patients with HIV who initiated dialysis therapy after 1997. This may reflect the long-term complications of multidrug regimens, as well as improved survival from these regimens leading to prolonged exposure to ASCVD risk factors.
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