Cardiovascular disease among people living with HIV in Brazil

• DOI: 10.1111/tmi.13405
• Publication Date: 2020-04-19T07:33:36Z
• Authors: David C. Boettiger; Maria Mercedes Es...; Matthew G. Law; Valdiléa Veloso; Rosa A. Souza; Maria L. R. Ikeda; Paulo R. de Alenc...; Unai Tupinambás; Carlos Brites; Beatriz Grinsztejn; Jackeline O. Ggomes; Sayonara Ribeiro; Catherine C. McGowan; Karu Jayathilake; Jessica L. Castilho; Alexandre Grangeiro
• Keywords: Adult; Male; Anti-HIV Agents; HIV Infections; Middle Aged; Cohort Studies; 03 medical and health sciences; Age Distribution; 0302 clinical medicine; Cardiovascular Diseases; Risk Factors; Cause of Death; Humans; Female; Sex Distribution; Brazil; Proportional Hazards Models

AbstractObjectivesThere 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.MethodsCompeting risk regression to assess factors associated with CVD and all‐cause mortality in the HIV‐Brazil Cohort Study between 2003 and 2014.ResultsAmong 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).ConclusionsTraditional 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.