Risk Factors for Coronary Heart Disease in Patients Treated for Human Immunodeficiency Virus Infection Compared with the General Population

TLDR

The study compared cardiovascular risk factor distributions in 35‑44‑year‑old HIV‑1–treated patients with a population cohort and highlighted the need to assess these factors at antiretroviral therapy initiation to guide interventions. Researchers evaluated prevalence of hypertension, HDL, smoking, waist‑to‑hip ratio, triglycerides, and other metabolic markers in HIV‑1–treated men and women versus uninfected controls to quantify cardiovascular risk. HIV‑1–treated men showed lower hypertension and HDL but higher smoking, waist‑to‑hip ratio, and triglycerides; women displayed similar patterns; predicted coronary heart disease risk was 20% higher in men and 59% higher in women, with smoking accounting for 65% and 29% of the attributable risk, respectively.

Abstract

The distribution of risk factors for cardiovascular disease in patients aged 35–44 years who were treated for human immunodeficiency virus type 1 (HIV-1) infection was compared with that for a population-based cohort. HIV-1-infected men treated with a protease inhibitor-containing regimen (n = 223), compared with HIV-1-uninfected men (n = 527), were characterized by a lower prevalence of hypertension, a lower mean high-density lipoprotein cholesterol level, a higher prevalence of smoking, a higher mean waist-to-hip ratio, and a higher mean triglyceride level. No difference was found for total plasma or low-density cholesterol levels, nor for the prevalence of diabetes. Similar trends were observed among female subjects. The predicted risk of coronary heart disease was greater among HIV-1-infected men (relative risk [RR], 1.20) and women (RR, 1.59; P < 10-6 for both), compared with the HIV-1-uninfected cohort. The estimated attributable risks due to smoking were 65% and 29% for HIV-1-infected men and women, respectively. Because most HIV-1-infected people will ultimately need antiretroviral therapy, risk factors for cardiovascular disease should be determined at the initiation of treatment, and interventions should be considered for all patients who have them.