title: Traditional and HIV-specific risk factors for cardiovascular morbidity and mortality among HIV-infected adults in Brazil: a retrospective cohort study.
abstract: BACKGROUND
  Antiretroviral therapy (ART) agents potentially associated with adverse metabolic profiles are commonly used in low- and middle-income countries. We assessed risk factors for cardiovascular disease (CVD)-related morbidity and mortality in a cohort of HIV-infected, ART-treated adults in Rio de Janeiro, Brazil.
  
  
  METHODS
  Hospital records and mortality data between 2000-2010 were examined for incident CVD-related ICD-10 and Coding of Death in HIV diagnoses among adults ≥18 years old on ART, enrolled in an observational cohort. Poisson regression models assessed associations between demographic and clinical characteristics and ART agent or class on CVD event risk.
  
  
  RESULTS
  Of 2960 eligible persons, 109 had a CVD event (89 hospitalizations, 20 deaths). Participants were 65 % male, 54 % white, and had median age of 37 and 4.6 years on ART. The median nadir CD4(+) T lymphocyte count was 149 cells/mm(3). The virologic suppression rate at the end of study follow-up was 60 %. In multivariable models, detectable HIV-1 RNA prior to the event, prior CVD, less time on ART, age ≥40 at study baseline, nadir CD4(+) T lymphocyte count ≤50 cells/mm(3), non-white race, male gender, and a history of hypertension were significantly associated with CVD event incidence (p < 0.05), in order of decreasing strength. In multivariate models, cumulative use of tenofovir, zidovudine, efavirenz and ritonavir-boosted atazanavir, darunavir and/or lopinavir were associated with decreased CVD event risk. Recent tenofovir and boosted atazanavir use were associated with decreased risk, while recent stavudine, nevirapine and unboosted nelfinavir and/or indinavir use were associated with increased CVD event risk.
  
  
  CONCLUSIONS
  Virologic suppression and preservation of CD4(+) T-lymphocyte counts were as important as traditional CVD risk factor burden in determining incident CVD event risk, emphasizing the overall benefit of ART on CVD risk and the need for metabolically-neutral first- and second-line ART in resource-limited settings.
authors: UCLA David Geffen School of Medicine, University of California, 11075 Santa Monica Blvd. St. 100, Los Angeles, 90025, CA, USA.|Montefiore University Hospital of Albert Einstein College of Medicine, Bronx, NY, USA.
authors: Chanelle M
authors: CM
authors: Diaz
authors: UCLA David Geffen School of Medicine, University of California, 11075 Santa Monica Blvd. St. 100, Los Angeles, 90025, CA, USA.
authors: Eddy R
authors: ER
authors: Segura
authors: Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Brazil.
authors: Paula M
authors: PM
authors: Luz
authors: UCLA David Geffen School of Medicine, University of California, 11075 Santa Monica Blvd. St. 100, Los Angeles, 90025, CA, USA.
authors: Jesse L
authors: JL
authors: Clark
authors: Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Brazil.
authors: Sayonara R
authors: SR
authors: Ribeiro
authors: Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Brazil.
authors: Raquel
authors: R
authors: De Boni
authors: Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Brazil.
authors: Leonardo
authors: L
authors: Eksterman
authors: Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Brazil.
authors: Rodrigo
authors: R
authors: Moreira
authors: UCLA David Geffen School of Medicine, University of California, 11075 Santa Monica Blvd. St. 100, Los Angeles, 90025, CA, USA.
authors: Judith S
authors: JS
authors: Currier
authors: Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Brazil.
authors: Valdiléa G
authors: VG
authors: Veloso
authors: Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Brazil.
authors: Beatriz
authors: B
authors: Grinsztejn
authors: UCLA David Geffen School of Medicine, University of California, 11075 Santa Monica Blvd. St. 100, Los Angeles, 90025, CA, USA. JLake@mednet.ucla.edu.
authors: Jordan E
authors: JE
authors: Lake
mesh_terms: D000328:Adult; D000367:Age Factors; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D044383:Black People; D001938:Brazil / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000401:mortality; D015331:Cohort Studies; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology; D015497:HIV-1 / Q000235:genetics; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012367:RNA, Viral / Q000097:blood; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D019562:Viral Load; D044465:White People
chemical_list: D019380:Anti-HIV Agents; D012367:RNA, Viral
keywords: AIDS; Antiretroviral therapy; Brazil; Cardiovascular disease; HIV