Cardiovascular events in delayed presentation of HIV: the prospective PISCIS cohort study

Objectives: People with HIV (PWH) have a higher cardiovascular risk than the general population. It remains unclear, however, whether the risk of cardiovascular disease (CVD) is higher in late HIV presenters (LP; CD4 ? 350 cells/?L at HIV diagnosis) compared to PWH diagnosed early. We aimed to asses...

Descripción completa

Detalles Bibliográficos
Autores: Martín-Iguacel, R., Vázquez Friol, María del Carmen, Burgos, J., Bruguera, A., Reyes-Urueña, J., Moreno-Fornés, S., Aceitón, J., Díaz, Y., Domingo, P., Saumoy, M., Knobel, H., Dalmau, D., Borjabad, B., Johansen, I.S., Miro, J.M., Casabona, J., Llibre, J.M.
Tipo de recurso: artículo
Fecha de publicación:2023
País:España
Institución:Servizo Galego de Saúde (SERGAS)
Repositorio:RUNA. Repositorio da Consellería de Sanidade e Sergas
OAI Identifier:oai:runa.sergas.gal:20.500.11940/21184
Acceso en línea:https://portalcientifico.sergas.gal//documentos/64be330d3bbfc602eae59382
http://hdl.handle.net/20.500.11940/21184
Access Level:acceso abierto
Palabra clave:AS Ferrol
CHUF
id ES_6f06acec0bb358cfa467c7e2d3ef1314
oai_identifier_str oai:runa.sergas.gal:20.500.11940/21184
network_acronym_str ES
network_name_str España
repository_id_str
spelling Cardiovascular events in delayed presentation of HIV: the prospective PISCIS cohort studyMartín-Iguacel, R.Vázquez Friol, María del CarmenBurgos, J.Bruguera, A.Reyes-Urueña, J.Moreno-Fornés, S.Aceitón, J.Díaz, Y.Domingo, P.Saumoy, M.Knobel, H.Dalmau, D.Borjabad, B.Johansen, I.S.Miro, J.M.Casabona, J.Llibre, J.M.AS FerrolCHUFObjectives: People with HIV (PWH) have a higher cardiovascular risk than the general population. It remains unclear, however, whether the risk of cardiovascular disease (CVD) is higher in late HIV presenters (LP; CD4 ? 350 cells/?L at HIV diagnosis) compared to PWH diagnosed early. We aimed to assess the rates of incident cardiovascular events (CVEs) following ART initiation among LP compared to non-LP. Methods: From the prospective, multicentre PISCIS cohort, we included all adult people with HIV (PWH) initiating antiretroviral therapy (ART) between 2005 and 2019 without prior CVE. Additional data were extracted from public health registries. The primary outcome was the incidence of first CVE (ischemic heart disease, congestive heart failure, cerebrovascular, or peripheral vascular disease). The secondary outcome was all-cause mortality after the first CVE. We used Poisson regression. Results: We included 3,317 PWH [26 589.1 person/years (PY)]: 1761 LP and 1556 non-LP. Overall, 163 (4.9%) experienced a CVE [IR 6.1/1000PY (95%CI: 5.3-7.1)]: 105 (6.0%) LP vs. 58 (3.7%) non-LP. No differences were observed in the multivariate analysis adjusting for age, transmission mode, comorbidities, and calendar time, regardless of CD4 at ART initiation [aIRR 0.92 (0.62-1.36) and 0.84 (0.56-1.26) in LP with CD4 count <200 and 200- ? 350 cells/?L, respectively, compared to non-LP]. Overall mortality was 8.5% in LP versus 2.3% in non-LP (p < 0.001). Mortality after the CVE was 31/163 (19.0%), with no differences between groups [aMRR 1.24 (0.45-3.44)]. Women vs. MSM and individuals with chronic lung and liver disease experienced particularly high mortality after the CVE [aMRR 5.89 (1.35-25.60), 5.06 (1.61-15.91), and 3.49 (1.08-11.26), respectively]. Sensitivity analyses including only PWH surviving the first 2 years yielded similar results. Conclusion: CVD remains a common cause of morbidity and mortality among PWH. LP without prior CVD did not exhibit an increased long-term risk of CVE compared with non-LP. Identifying traditional cardiovascular risk factors is essential for CVD risk reduction in this population.This work was supported by scholarships from the University of Southern Denmark, the Danish AIDS-foundation, and Public Regional Funds. JM received a personal 80:20 research grant from Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain, during 2017-23. The study was investigator-driven and thus independent of any pharmaceutical company. The funding sources were not involved in study design, data collection, analyses, report writing, or the decision to submit the paper.2023info:eu-repo/semantics/articlehttps://portalcientifico.sergas.gal//documentos/64be330d3bbfc602eae59382http://hdl.handle.net/20.500.11940/21184reponame:RUNA. Repositorio da Consellería de Sanidade e Sergasinstname:Servizo Galego de Saúde (SERGAS)Ingléshttp://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:runa.sergas.gal:20.500.11940/211842026-06-12T08:40:47Z
dc.title.none.fl_str_mv Cardiovascular events in delayed presentation of HIV: the prospective PISCIS cohort study
title Cardiovascular events in delayed presentation of HIV: the prospective PISCIS cohort study
spellingShingle Cardiovascular events in delayed presentation of HIV: the prospective PISCIS cohort study
Martín-Iguacel, R.
AS Ferrol
CHUF
title_short Cardiovascular events in delayed presentation of HIV: the prospective PISCIS cohort study
title_full Cardiovascular events in delayed presentation of HIV: the prospective PISCIS cohort study
title_fullStr Cardiovascular events in delayed presentation of HIV: the prospective PISCIS cohort study
title_full_unstemmed Cardiovascular events in delayed presentation of HIV: the prospective PISCIS cohort study
title_sort Cardiovascular events in delayed presentation of HIV: the prospective PISCIS cohort study
dc.creator.none.fl_str_mv Martín-Iguacel, R.
Vázquez Friol, María del Carmen
Burgos, J.
Bruguera, A.
Reyes-Urueña, J.
Moreno-Fornés, S.
Aceitón, J.
Díaz, Y.
Domingo, P.
Saumoy, M.
Knobel, H.
Dalmau, D.
Borjabad, B.
Johansen, I.S.
Miro, J.M.
Casabona, J.
Llibre, J.M.
author Martín-Iguacel, R.
author_facet Martín-Iguacel, R.
Vázquez Friol, María del Carmen
Burgos, J.
Bruguera, A.
Reyes-Urueña, J.
Moreno-Fornés, S.
Aceitón, J.
Díaz, Y.
Domingo, P.
Saumoy, M.
Knobel, H.
Dalmau, D.
Borjabad, B.
Johansen, I.S.
Miro, J.M.
Casabona, J.
Llibre, J.M.
author_role author
author2 Vázquez Friol, María del Carmen
Burgos, J.
Bruguera, A.
Reyes-Urueña, J.
Moreno-Fornés, S.
Aceitón, J.
Díaz, Y.
Domingo, P.
Saumoy, M.
Knobel, H.
Dalmau, D.
Borjabad, B.
Johansen, I.S.
Miro, J.M.
Casabona, J.
Llibre, J.M.
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv AS Ferrol
CHUF
topic AS Ferrol
CHUF
description Objectives: People with HIV (PWH) have a higher cardiovascular risk than the general population. It remains unclear, however, whether the risk of cardiovascular disease (CVD) is higher in late HIV presenters (LP; CD4 ? 350 cells/?L at HIV diagnosis) compared to PWH diagnosed early. We aimed to assess the rates of incident cardiovascular events (CVEs) following ART initiation among LP compared to non-LP. Methods: From the prospective, multicentre PISCIS cohort, we included all adult people with HIV (PWH) initiating antiretroviral therapy (ART) between 2005 and 2019 without prior CVE. Additional data were extracted from public health registries. The primary outcome was the incidence of first CVE (ischemic heart disease, congestive heart failure, cerebrovascular, or peripheral vascular disease). The secondary outcome was all-cause mortality after the first CVE. We used Poisson regression. Results: We included 3,317 PWH [26 589.1 person/years (PY)]: 1761 LP and 1556 non-LP. Overall, 163 (4.9%) experienced a CVE [IR 6.1/1000PY (95%CI: 5.3-7.1)]: 105 (6.0%) LP vs. 58 (3.7%) non-LP. No differences were observed in the multivariate analysis adjusting for age, transmission mode, comorbidities, and calendar time, regardless of CD4 at ART initiation [aIRR 0.92 (0.62-1.36) and 0.84 (0.56-1.26) in LP with CD4 count <200 and 200- ? 350 cells/?L, respectively, compared to non-LP]. Overall mortality was 8.5% in LP versus 2.3% in non-LP (p < 0.001). Mortality after the CVE was 31/163 (19.0%), with no differences between groups [aMRR 1.24 (0.45-3.44)]. Women vs. MSM and individuals with chronic lung and liver disease experienced particularly high mortality after the CVE [aMRR 5.89 (1.35-25.60), 5.06 (1.61-15.91), and 3.49 (1.08-11.26), respectively]. Sensitivity analyses including only PWH surviving the first 2 years yielded similar results. Conclusion: CVD remains a common cause of morbidity and mortality among PWH. LP without prior CVD did not exhibit an increased long-term risk of CVE compared with non-LP. Identifying traditional cardiovascular risk factors is essential for CVD risk reduction in this population.
publishDate 2023
dc.date.none.fl_str_mv 2023
dc.type.none.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv https://portalcientifico.sergas.gal//documentos/64be330d3bbfc602eae59382
http://hdl.handle.net/20.500.11940/21184
url https://portalcientifico.sergas.gal//documentos/64be330d3bbfc602eae59382
http://hdl.handle.net/20.500.11940/21184
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv http://creativecommons.org/licenses/by/4.0/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv http://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
dc.source.none.fl_str_mv reponame:RUNA. Repositorio da Consellería de Sanidade e Sergas
instname:Servizo Galego de Saúde (SERGAS)
instname_str Servizo Galego de Saúde (SERGAS)
reponame_str RUNA. Repositorio da Consellería de Sanidade e Sergas
collection RUNA. Repositorio da Consellería de Sanidade e Sergas
repository.name.fl_str_mv
repository.mail.fl_str_mv
_version_ 1869410465967243264
score 15,811543

Similares en LA Referencia