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fmed-10-1182359.pdf (458.15 KB)

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2023-06-21

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cc by (c) Martín iguacel, Raquel et al, 2023
Si us plau utilitzeu sempre aquest identificador per citar o enllaçar aquest document: https://hdl.handle.net/2445/201103

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

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https://doi.org/10.3389/fmed.2023.1182359

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ObjectivesPeople 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 & LE; 350 cells/& mu;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. MethodsFrom 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. ResultsWe 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- & LE; 350 cells/& mu;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. ConclusionCVD 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.

Matèries

Persones seropositives, Malalties cardiovasculars

Matèries (anglès)

HIV-positive persons, Cardiovascular diseases

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Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))

Citació

MARTÍN IGUACEL, Raquel, VAZQUEZ FRIOL, Mari carmen, BURGOS, Joaquin, BRUGUERA, Andreu, REYES URUEÑA, Juliana, MORENO FORNÉS, Sergio, ACEITON, Jordi, DÍAZ, Yesika, DOMINGO, Pere (domingo pedrol), SAUMOY, Maria, KNOBEL, Hernando, DALMAU JUANOLA, David, BORJABAD, Beatriz, JOHANSEN, Isik somuncu, MIRÓ MEDA, José m. (josé maría), CASABONA, Jordi, LLIBRE, Josep maría, PISCIS study group. Cardiovascular events in delayed presentation of HIV: the prospective PISCIS cohort study. _Frontiers in Medicine_. 2023. Vol. 10. [consulta: 23 de gener de 2026]. ISSN: 2296-858X. [Disponible a: https://hdl.handle.net/2445/201103]

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