Increased Risk for Cardiovascular Disease in People Living With HIV

Individuals living with HIV, particularly those with comorbid kidney disease, were found to be at increased risk for cardiovascular disease, according to a study published in Arteriosclerosis, Thrombosis, and Vascular Biology.

Data from 9 studies of patients with HIV (n=986) were pooled with data from 2 cohorts of HIV-negative participants (n=1547). Data from brachial artery ultrasounds and standard clinical laboratory testing were analyzed.

In the HIV-positive and HIV-negative cohorts: mean age was 44.4±11.8 years and 42.9±12.2 years, respectively; 13% and 54.8% were women, respectively; 60.4% and 84.2% were White respectively; and 33.2% and 88.9% were smokers, respectively.

Low flow-mediated dilation (FMD) was found to be associated with HIV status after controlling for creatinine (b, -0.89%; 95% CI, -1.61% to -0.17%; P =.015).

Predictors of low FMD included: large baseline brachial artery diameter (b, -24.23%; 95% CI, -27.56% to -20.90; P <.001), female gender (b, -1.48%; 95% CI, -1.99% to -0.98%; P <.001), lower body mass index (b, 0.26%; 95% CI, 0.10%-0.41%; P <.001), heart rate (b, 0.22%; 95% CI, 0.06%-0.38%; P =.007), non-high density lipoprotein cholesterol (b, 0.06%; 95% CI, 0.01%-0.11%; P =.013), and age (b, -0.09%; 95% CI, -0.17% to -0.01%; P =.027).

People living with HIV had higher creatinine levels compared with control individuals (0.96±0.21 mg/dL vs 0.92±0.28 mg/dL, respectively; P <.001). Lower FMD and creatinine were more strongly correlated in people living with vs without HIV (r, -9.14 vs r, -0.05, respectively).

With a reduced model including only HIV status, age, ethnicity, and creatinine concentration, both HIV status (b, -1.25; standard error [SE], 0.39; P =.001) and creatinine concentration (b, -0.72; SE, 0.32; P =.024) were found to be independently associated with FMD.

A stronger association between FMD and HIV was observed in participants with a creatinine concentration >1.0 mg/dL (b, -1.59%; 95% CI, -2.58% to -0.60%; P =.002).

Brachial artery diameter was associated with age, gender, body mass index (P <.001 for all), and diastolic blood pressure (P =.004). Among individuals living with HIV, RNA viremia (P <.001), undetectable status (P =.002), and anti-retroviral therapy use (P =.007) were inversely associated with brachial artery diameter.

This study was limited by the pooling of multiple datasets, which did not allow for many subanalyses, such as HIV subtype, to be performed.

These data indicate that individuals living with HIV may be at increased risk of developing cardiovascular disease due to impaired endothelial function. This risk was found to be increased among individuals with mild kidney dysfunction.

Reference

Stein J H, Kime N, Korcarz C E, et al. Effects of HIV infection on arterial endothelial function: Results from a large pooled cohort analysis. Arterioscler Thromb Vasc Biol. 2020;ATVBAHA120315435. doi:10.1161/ATVBAHA.120.315435