Cardiovascular risk factors in HIV infected individuals: Comparison with general adult control population in Greece.

Giota Touloumi,Helen Sambatakou,Mina Psichogiou,Anastasia Antoniadou,Vasileios Papastamopoulos,George Chrysos,Konstantinos Makrilakis,Grigoris Chlouverakis,Yannis Alamanos,Vasilios Paparizos,Natasa Kalpourtzi,Magda Gavana,Paraskevi V Voulgari,Christos Hadjichristodoulou,Nikolaos V Sipsas,Maria Chini,Charalambos Gogos,Simeon Metallidis,Georgios Adamis,Argiro Karakosta,Apostolos Vantarakis,George S Stergiou ,G Tripsianis ,Emeno

doi:10.1371/journal.pone.0230730

Abstract

BackgroundAlthough combined antiretroviral therapy has substantially improved the prognosis of people living with HIV (PLHIV), mortality remains higher compared to the general population, mainly due to higher prevalence of non-HIV-related comorbidities, including cardiovascular diseases (CVD). We assessed the prevalence of CVD risk and its contributing factors in adult PLHIV versus general population controls in Greece.SettingsCross-sectional comparison of PLHIV (Athens-Multicenter-AIDS-Cohort-Study; AMACS) versus general population controls (National health examination survey; EMENO).MethodsAll HIV-infected adults with ≥1 measurement of interest (blood pressure, lipids, glucose, weight, height) between 2012–2014 and all EMENO participants (2014–2016) were included. Ten-year total CVD risk was estimated using the Framingham (FRS) or the Systematic Coronary Risk Evaluation (SCORE) equations.Results5839 PLHIV (median age:41.6 years, 85.4% males) and 4820 controls (median age:48 years, 48.4% males) were included. Adjusting for age, sex and origin, PLHIV were more likely to be current smokers (adjusted OR:1.53 [95% CI:1.35–1.74]) and dyslipidemic (aOR:1.18; [1.04–1.34]), less likely to be obese (aOR:0.44 [0.38–0.52], with no differences in hypertension, diabetes or high (≥20%) FRS but with greater odds of high (≥5%) SCORE (aOR:1.55 [1.05–2.30]). Further adjustment for educational level, anti-HCV positivity and BMI showed higher prevalence of hypertension in PLHIV.ConclusionsDespite the relative absence of obesity, PLHIV have higher prevalence of traditional CVD risk factors and higher risk of fatal CVD compared to general population. Regular screening and early management of CVD risk factors in PLHIV should be of high priority for CVD prevention.

Highlights

Mortality among people living with HIV (PLHIV) has decreased substantially since the introduction of combined antiretroviral therapy
Combined antiretroviral therapy has substantially improved the prognosis of people living with HIV (PLHIV), mortality remains higher compared to the general population, mainly due to higher prevalence of non-HIV-related comorbidities, including cardiovascular diseases (CVD)
Despite the relative absence of obesity, PLHIV have higher prevalence of traditional CVD risk factors and higher risk of fatal CVD compared to general population

Summary

Introduction

Mortality among people living with HIV (PLHIV) has decreased substantially since the introduction of combined antiretroviral therapy (cART). Remain higher in PLHIV compared to the general population [1,2,3]. The difference is mainly attributed to the higher prevalence of non-HIV related comorbidities, with cardiovascular diseases (CVD) being the most important contributor [4,5,6,7]. Higher prevalence of modifiable CVD risk factors among HIV-infected as compared to HIV negative individuals could be another contributing factor [11,12]. Combined antiretroviral therapy has substantially improved the prognosis of people living with HIV (PLHIV), mortality remains higher compared to the general population, mainly due to higher prevalence of non-HIV-related comorbidities, including cardiovascular diseases (CVD). We assessed the prevalence of CVD risk and its contributing factors in adult PLHIV versus general population controls in Greece.

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Conclusion