Rates of cardiovascular events and deaths are associated with advanced stages of HIV-infection: results of the HIV HEART study 7, 5 year follow-up.
BACKGROUND
Cardiovascular diseases are increasing in aging HIV-positive patients (HIV+). Impact of traditional cardiovascular risk factors, HIV-specific parameters and antiretroviral therapy (ART) on the incidence of cardiovascular events (CVE) and on the mortality rate are investigated in different HIV+ cohorts.


METHODS
The HIV HEART (HIVH) study is an ongoing prospective observational cohort study in the German Ruhr area to assess the frequency and clinical course of cardiac disorders in 1481 HIV+ by standardized non-invasive cardiovascular screening. CVE were defined as diagnosed or documented myocardial infarction, coronary heart disease, arterial coronary intervention, stent implantation, bypass operation and stroke.


RESULTS
1481 HIV+ subjects (mean age: 49.3±10.7 years (y), female: 15.6%) were included. 130 CVE and 90 deaths were documented until the end of 7, 5 year follow-up of HIVH. Mean duration of the HIV-infection was 12.9±6.8 y. HIV+ were treated with ART on average for 8.6±6.8 y. According to the CDC classification of the HIV-infection, HIV+ were distributed over the clinical categories (A:34.6%; B:31.4% and C:33.9%) while more than the half had an advanced immunodeficiency (I:8.3%; II:41.1%; III:50.7%). Advanced clinical and immunological stages were significantly (p<0.001) associated with higher incidences of deaths (A:16.7%; B:26.7%; C:56.7% and I:6.7%; II:27.7%; III:65.6%) and CVE (A:17.7%; B:33.1%; C:49.2% and I:3.1%; II:32.3%; III:64.6%) but not with the duration of HIV-infection (per y: Hazard ratio (HR): 0.91 [0.88-0.94]) and ART (per y: HR: 0.81 [0.79-0.84]) adjusted for age. The proportion of deceased HIV+ with HIV-RNA ≥50 copies/mL and lower CD4-cell counts at their last visit is significantly higher compared with living HIV+ without CVE (HIV-RNA ≥50 copies/mL: 25.6% vs 14.7%). Median CD4-cells: 286.5 cells/µL (IQR: 168.8-482.8) versus 574 cells/µL (IQR: 406-786). 96.1% of the living HIV+ with CVE had HIV-RNA<50 copies/mL and median CD4-cells 542.5 cells/µL (IQR: 370-793.5).


CONCLUSIONS
Advanced clinical and immunological stages of HIV-infection, but not the duration of ART, were associated with higher incidences of CVE and deaths in the HIVH cohort. These observations support an earlier initiation of ART in HIV+. Special cardiovascular risk calculations for HIV+ should consider immunological and clinical categories of the HIV-infection.
Dermatology and Venerology, University Hospital Essen, Essen, Germany.
Stefan
S
Esser
Institute for Medical Informatics, University Hospital Essen, Essen, Germany.
Lewin
L
Eisele
Cardiology, University Hospital Essen, Essen, Germany.
Birte
B
Schwarz
Cardiology, University Hospital Essen, Essen, Germany.
Christina
C
Schulze
Clinical Trial Centre Leipzig, University Leipzig, Leipzig, Germany.
Volker
V
Holzendorf
Department of Dermatology and Venerology, University Hospital Bochum, Bochum, Germany.
Nobert H
NH
Brockmeyer
Internal Medicine, City Hospital Dortmund, Dortmund, Germany.
Martin
M
Hower
General Practice, HIV-Medicine, Duisburg, Germany.
Friedhelm
F
Kwirant
HIV-Medicine, Outpatient-Clinic of Oncology, Essen, Germany.
Roland
R
Rudolph
Cardiology, University Hospital Essen, Essen, Germany.
Till
T
Neumann
Cardiology, University Hospital Essen, Essen, Germany.
Nico
N
Reinsch