Abstract 18068: Trends in Proportionate Cardiovascular Mortality Among Adults With Human Immunodeficiency Virus in the United States: 1999-2013

Abstract

Introduction: Due to the success of antiretroviral therapy, Human Immunodeficiency Virus (HIV)-infected individuals live longer and are at risk for cardiovascular disease (CVD). Whether the proportion of deaths due to CVD in the HIV-infected population has increased over time is unknown. Hypothesis: Our hypothesis was that proportionate mortality from CVD in the HIV-infected population has increased significantly since 1999. Methods: Using the publicly available CDC Wonder database of U.S. national mortality data, we assessed proportionate CVD mortality among adults aged ≥25 years with HIV. We compared these data to proportionate CVD mortality in two control groups: the general population and people with underlying inflammatory disease (i.e., inflammatory polyarthropathies (IPA)). For each group, we calculated proportionate CVD mortality by dividing deaths attributed to circulatory causes (based on ICD10 coding) by all causes of death for each year from 1999 to 2013. Results: Proportionate CVD mortality increased among HIV+ individuals from 1.9% of deaths in 1999 to 4.6% in 2013 (Figure 1); this pattern of increasing proportionate mortality was highly significant for men and women (P<0.01) and consistent across race groups. Meanwhile, proportionate CVD mortality declined in the general population (41% in 1999 to 32% in 2013; P<0.01) and IPA population (40% in 1999 to 29% in 2013; P<0.01). A sensitivity analysis including only in-hospital deaths also revealed a highly significant increase in proportionate CVD mortality for HIV-infected individuals, from 2.1% in 1999 to 3.9% in 2013 (P<0.01). Hypertensive and pulmonary heart diseases were 2-3 times more likely to be the cause of death in the HIV population than in the general population. Conclusions: Proportionate CVD mortality appears to have increased substantially in the HIV-infected population since 1999. Further studies are needed to guide risk assessment and prevention in this unique population.