Associations between HIV viremia during antiretroviral therapy and cardiovascular disease. (1st November 2022)

• Record Type: Journal Article
• Authors: Elvstam, Olof; Marrone, Gaetano; Engström, Gunnar; Nilsson, Peter M.; Carlander, Christina; Treutiger, Carl Johan; Gisslén, Magnus; Björkman, Per
• Is Part Of: AIDS. Volume 36:Number 13(2022)
• Page Start: 1829
• Page End: 1834
• Publication Date: 2022-11-01
• Subjects: cardiovascular diseases -- HIV infections/epidemiology -- myocardial ischemia -- stroke -- viremia; AIDS (Disease) -- Periodicals; Acquired Immunodeficiency Syndrome; AIDS (Disease); Periodicals; Periodicals; 616.9792005
• DOI: 10.1097/QAD.0000000000003240
• Languages: English
• ISSNs: 0269-9370

Abstract

Abstract : Objective: To investigate the association between HIV viremia exposure during antiretroviral therapy (ART) and cardiovascular disease (CVD) risk. Design: Nationwide observational cohort. Methods: Participants (age >15 years) from the Swedish nationwide InfCareHIV register initiating ART 1996–2017 were categorized in a time-updated manner into four viremia categories, starting from 12 months after ART initiation: suppression (<50 copies/ml), low-level viremia (50–199 copies/ml and 200–999 copies/ml, respectively), and high-level viremia (≥1000 copies/ml). In addition, cumulative viremia was estimated as the area under the log viral load (VL) curve. Proportional subhazard models adjusted for sex, age, pre-ART CD4 and VL, injection drug use, and country of birth were used to analyze the association between viremia exposure and CVD risk (ischemic heart disease, stroke, and heart failure; data obtained by linkage to national registers), accounting for the competing risk of non-CVD death. Results: In all, 337 cases of CVD were observed during 44 937 person-years of follow-up ( n = 6562). Higher viremia exposure was associated with CVD, both when parameterized as cumulative viremia (adjusted subhazard ratio [aSHR] per 1 log10 copy × year/ml, 1.03; 95% confidence interval [CI], 1.01–1.05) and as viremia category (aSHR for high-level viremia versus suppression, 1.45; 95% CI, 1.03–2.05). We observed no association between CVD and low-level viremia compared with those with suppression. Conclusions: Higher exposure to HIV viremia was linked to CVD in ART recipients, whereas no increased risk was detected for people with low-level viremia compared with viral suppression. Causal inference is limited by the observational nature of this study.