The Association of Cardiovascular Risk Factors and Disease in People With HIV in the UK: A Retrospective Matched Cohort Study

Abstract

Background: Evidence suggest that people living with HIV have an increased risk of cardiovascular disease (CVD); however, studies are often older, not population-based, and focus on specific CVD events. The current risk is unknown due to limitations of previous study designs and changes to HIV treatment and management over the last decade. We aimed to identify the risk of composite CVD, individual CVD events and common risk factors. Methods: In this nationwide retrospective population-based matched cohort study, we identified all adults (≥18y) with HIV from The Health Improvement Network (THIN) database between January 1, 2000 and January 1, 2020. People with HIV were matched with up to four HIV-negative individuals based on age, sex, ethnicity, and location. The primary outcome was composite CVD comprising stroke, myocardial infarction (MI), peripheral vascular disease (PVD), ischaemic heart disease (IHD), and heart failure (HF). The secondary outcomes were individual CVD events, hypertension, diabetes, chronic kidney disease (CKD), and all-cause mortality. Cox proportional hazard regression models were used to examine the risk of each outcome. Findings: We identified 9233 people with HIV and 35721 HIV-negative individuals. We report an increased risk for composite CVD (adjusted hazard ratio [aHR] 1 · 50, 95% CI 1·28-1·77), stroke (aHR 1·42, 95% CI 1·08-1·86), IHD (aHR 1·55, 95% CI 1·24-1·94), hypertension (aHR 1·37, 95% CI 1·23-1·53), type 2 diabetes (aHR 1·28, 95% CI 1·09-1·50), CKD (aHR 2·42, 95% CI 1·98-2·94), and all-cause mortality (aHR 2·84, 95% CI (2·48-3·25), but not for PVD, MI, or HF. Interpretation: Despite improvements in managing HIV and ART-related side effects, an increased risk for CV risk factors and disease remains. This reinforces the importance for regular screening for CV risk factors and disease, targeted prevention strategies and better management of such conditions. Funding: No funding. Declaration of Interests: KJ is part funded by the National Institute for Health Research (NIHR) Applied Research Centre (ARC) West Midlands. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. Authors have no other conflict of interests to disclose. Ethics Approval Statement: Ethical approval was received by the Scientific Review Committee on February 15, 2021 (SRC reference number: 20SRC067).