Göran Bratt, Catharina Missalidis, Anders Blaxhult

Affiliates

Vednhälsan, Department of Venhälsan/Infectious Disease clinic, Södersjukhuset, 11883 Stockholm, SXweden

Abstract

Background: HIV is now a chronic condition associated with premature age-related comorbidities and increased risk of cardiovascular disease (CVD). The aims of this study were:
1. To describe the prevalence of severe CVD (defined by myocardial infarction, unstable angina, NSTENI needing revascularization, repeated TIA, stroke or severe arterial insufficiency in lower extremities needing revascularization) events after HIV-diagnosis, in 2012
2. To study the incidence of severe CVD during 5 years follow up
3. To study which factors predicted CVD co-morbidity
– in a reallife situation in a cohort of 50+ HIV-positive individuals (n=570) with a close to 100% ART coverage.
Material and Methods: 79% (450/570) were MSM; 12% (66/570) were females. Known time with HIV-infection was 17 years. The median age in 2012 was 55 years (range: 50-84 years). CD4 had increased from a median nadir of 190 x 10-6/L to 600 x 10-6/L. Of those 98% (556/570) on ART HIV-RNA was < 50 copies/ml in 96%.
Results:
1. In 2012 CVD had occurred in 16% (93/570) after HIV-diagnosis.
2. During 5.25 years follow up 7% (42/570) had developed a new CVD and 6% (35/570) had died (1.2/100 patient years).
3. In 2012 a history of stavudine or didanosine, a CD4 nadir3.0, a history of a CVD after HIV diagnosis, hypertension, the Metabolic syndrome (IDF05) and statin treatment were significantly associated with a new CVD event in univariate analysis. In multivariate analysis, controlled for age, only hsCRP ≥3.0 mg/L (OR 3.03 (1.52-6.06; p 0.002) remained significant.
Conclusion: We found a strong association between a history of CVD and smoking in 2012. Interestingly, only hsCRP ≥3.0 mg/L in 2012 was associated to a new CVD event during follow up, indicating the significance of a persistenst low-grade inflammatory state even in well suppressed HIV-infection. Our study underscores the importance of supporting a healthy life style and highlights the challenge of low grade inflammation in well treated HIV-infection.