title: Impact of clinical and therapeutic factors on incident cardiovascular and cerebrovascular events in a population-based cohort of HIV-infected and non-HIV-infected adults.
abstract: BACKGROUND
  Cardiovascular and cerebrovascular (CVD) events/diseases are a common cause of non-acquired immunodeficiency syndrome (AIDS)-related mortality in the aging human immunodeficiency virus (HIV)-infected population. The incidence rate and clinical correlates of CVD in people living with HIV/AIDS compared to the general population warrants further investigation.
  
  
  OBJECTIVE
  HIV/AIDS is associated with increased risk CVD compared to general population.
  
  
  METHODS
  CVD events in a matched cohort of HIV-infected and non-HIV-infected adults, ≥18 years old, served through the South Carolina Medicaid program during 1994 to 2011 were examined using time-dependent proportional hazards regression and marginal structural modeling.
  
  
  RESULTS
  A retrospective cohort of 13,632 adults was followed longitudinally for an average of 51 months. The adjusted hazard ratio (aHR) of incident CVD events was higher among HIV-infected individuals exposed to combination antiretroviral therapy (cART) (aHR = 1.15) compared to the non-HIV-infected group, but did not differ from the subgroup of cART-naïve HIV-infected adults. A higher aHR of incident CVD was associated with comorbid hypertension (aHR = 2.18), diabetes (aHR = 1.38), obesity (aHR = 1.30), tobacco use (aHR = 1.47), and hepatitis C coinfection (aHR = 1.32), and older age (aHR = 1.26), but with a lower risk among females (aHR = 0.86). A higher risk of incident CVD events was also apparent in HIV-infected individuals with exposure to both protease inhibitors (adjusted risk ratio [aRR] = 1.99) and non-nucleoside reverse transcriptase inhibitors (aRR = 2.19) compared to those with no exposure. Sustained viral load suppression was associated with a lower risk of incident CVD events (aRR = 0.74).
  
  
  CONCLUSIONS
  After adjusting for traditional risk factors and sociodemographic differences, there is higher risk of incident cardiovascular events among HIV-infected individuals exposed to combined antiretroviral medications compared to the general population.
authors.affiliation: Department of Medicine, University of Mississippi School of Medicine, Jackson, Mississippi.
authors.forename: Avnish
authors.initials: A
authors.lastname: Tripathi
authors.forename: Angela D
authors.initials: AD
authors.lastname: Liese
authors.forename: Michael D
authors.initials: MD
authors.lastname: Winniford
authors.forename: Jeanette M
authors.initials: JM
authors.lastname: Jerrell
authors.forename: Helmut
authors.initials: H
authors.lastname: Albrecht
authors.forename: Ali A
authors.initials: AA
authors.lastname: Rizvi
authors.forename: Jiajia
authors.initials: J
authors.lastname: Zhang
authors.forename: Wayne A
authors.initials: WA
authors.lastname: Duffus
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000009:adverse effects; D023241:Antiretroviral Therapy, Highly Active; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology*; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008484:Medicaid; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013022:South Carolina / Q000453:epidemiology; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D019562:Viral Load; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents