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The association of cardiovascular risk factors and disease in people living with HIV in the UK: a retrospective matched cohort study

Title
The association of cardiovascular risk factors and disease in people living with HIV in the UK: a retrospective matched cohort study
Presenter
Tiffany Gooden
Authors
T. Gooden * (1), M. Gardner (1), J. Wang (1), K. Jolly (1), D.A Lane (1,2), L.A Benjamin (3,4,5), H.C Mwandumba (6,7), V. Kandoole (6,8,9), S. Manaseki-Holland (1), G.YH Lip (1,2), K. Nirantharakumar (1), GN. Thomas (1).
Institutions
(1) University of Birmingham, Institute of Applied Health Research, Birmingham, United Kingdom, (2) University of Liverpool, Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom, (3) University College London, Laboratory of Molecular and Cell Biology, London, United Kingdom, (4) University College London, Stroke Research Centre, London, United Kingdom, (5) University of Liverpool, Institute of Infection, Veterinary and Ecological Sciences, Liverpool, United Kingdom, (6) University of Malawi, Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi, (7) Liverpool School of Tropical Medicine, Department of Clinical Sciences, Liverpool, United Kingdom, (8) University of Malawi, College of Medicine, Blantyre, Malawi, (9) University Hospitals Bristol and Western NHS Foundation Trust, Bristol Heart Institute, Bristol, United Kingdom

BACKGROUND: Heightened risk of cardiovascular disease (CVD) and associated risk factors in people living with HIV (PLWH) have been reported in various settings; however, results are limited and differ geographically. We aimed to identify the association of CV risk factors and disease in PLWH compared to those without HIV in the UK.
METHODS: A matched cohort was derived from The Health Improvement Network (THIN) database from January 2000 to January 2020. Adult ('¥18y) people with an HIV diagnosis (exposed) were eligible and matched for gender and age with up to four people without HIV (unexposed). Outcomes included CVD (stroke, myocardial infarction (MI), peripheral vascular disease (PVD), ischaemic heart disease (IHD) and heart failure (HF)), hypertension, diabetes, chronic kidney disease (CKD), lipid-lowering drug use and all-cause mortality. Cox proportional hazard regression models were used to compare the risk of each outcome between the exposed and unexposed group.
RESULTS: The cohort comprised 9233 exposed and 35721 unexposed individuals; 34% were females and the mean age was 41. Across all models, the exposed group was at a higher risk for CVD (HR 1.54, 95% CI 1.30, 1.83), specifically stroke (HR 1.49, 95% CI 1.11, 2.00), hypertension (HR 1.37, 95% CI 1.22, 1.55), lipid-lowering drug use (HR 1.96, 95% CI 1.78, 2.16), CKD (HR 2.40, 95% CI 1.93, 2.98) and all-cause mortality (HR 2.68, 95% CI 2.32, 3.10). CVD risk remained significant across sub-groups of gender, age, smoking status and index year. Younger patients ('¤40y) had the highest risk of CVD (HR 2.01, 95% CI 1.29, 3.13) and all-cause mortality (HR 6.09, 95% CI 4.36, 8.51). Females had double the risk for MI (HR 2.67, 95% CI 1.02, 6.95) and IHD (HR 2.34, 95% CI 1.17, 4.71) whereas males had a slightly increased risk for stroke (HR 1.55, 95% CI 1.11, 2.15) and IHD (HR 1.47, 95% 1.14, 1.91).
CONCLUSIONS: PLWH, particularly of younger age, are at a heightened risk for mortality, cardiovascular risk factors and disease. Therefore, screening for CV risk factors and disease in PLWH should be routine. Further research is needed to ascertain the drivers of these risks to inform prevention strategies.