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Cardiovascular disease among people living with HIV in Brazil
David C Boettiger1,2, Maria Mercedes Escuder3, Matthew G Law2
1Institute for Health Policy Studies, University of California, San Francisco, CA, USA.
Insights
Cardiovascular disease (CVD) in people living with HIV (PLHIV) in Brazil is linked to older age, race, hypertension, dyslipidemia, smoking, and low CD4 counts. Past CVD events significantly increase mortality risk in PLHIV.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Limited data exists on cardiovascular disease (CVD) prevalence and risk factors among people living with HIV (PLHIV) in resource-limited settings.
- Understanding these factors is crucial for improving long-term health outcomes for PLHIV on antiretroviral therapy.
Purpose of the Study:
- To assess factors associated with CVD development in PLHIV in Brazil.
- To evaluate the impact of prevalent CVD on all-cause mortality in this population.
Main Methods:
- The study utilized competing risk regression analysis.
- Data was drawn from the HIV-Brazil Cohort Study spanning 2003-2014.
- 5614 PLHIV on antiretroviral therapy were included in the analysis.
Main Results:
- The incidence of CVD was 3.5 per 1000 person-years.
- Factors associated with CVD included older age, black race, prior CVD, hypertension, high-grade dyslipidemia, smoking, and low nadir CD4 count.
- All-cause mortality was 16.6 per 1000 person-years, with a history of CVD being a significant predictor of death.
Conclusions:
- Risk factors for CVD in Brazilian PLHIV mirror those found in high-income countries.
- PLHIV with a history of CVD face a substantially elevated risk of mortality.
- Prioritizing CVD care and treatment is essential for the aging PLHIV population in Brazil.
Objectives:
There is a paucity of data on cardiovascular disease (CVD) among people living with HIV (PLHIV) in resource-limited countries. We assessed factors associated with CVD and the impact of prevalent CVD on all-cause mortality in PLHIV on antiretroviral therapy in Brazil.
Methods:
Competing risk regression to assess factors associated with CVD and all-cause mortality in the HIV-Brazil Cohort Study between 2003 and 2014.
Results:
Among 5614 patients, the rate of CVD was 3.5 (95% confidence interval [95% CI] 2.9-4.3) per 1000 person-years. CVD was associated with older age (adjusted hazard ratio [aHR] 6.4 for ≥55 years vs. <35 years, 95% CI: 2.5-16.3, P < 0.01), black race (aHR 1.8 vs. white race, 95% CI: 1.0-3.1, P = 0.04), past CVD (aHR 3.0 vs. no past CVD, 95% CI: 1.4-6.2, P < 0.01), hypertension (aHR 1.8 vs. no hypertension, 95% CI: 1.0-3.1, P = 0.04), high-grade dyslipidemia (aHR 9.3 vs. no high-grade dyslipidemia, 95% CI: 6.0-14.6, P < 0.01), ever smoking (aHR 2.4 vs. never, 95% CI: 1.2-5.0, P = 0.02) and low nadir CD4 cell count (aHR 1.8 for 100-250 cells/mm3 vs. >250 cells/mm3 , 95% CI: 1.0-3.2, P = 0.05). The rate of death was 16.6 (95% CI: 15.1-18.3) per 1000 person-years. Death was strongly associated with having had a past CVD event (aHR 1.7 vs. no past CVD event, 95% CI: 1.1-2.7, P = 0.01).
Conclusions:
Traditional and HIV-specific factors associated with CVD among PLHIV in Brazil are similar to those identified among PLHIV in high-income countries. PLHIV in Brazil with a history of CVD have a high risk of death. CVD care and treatment remain priorities for PLHIV in Brazil as this population ages and antiretroviral therapy use expands.
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