Cardiovascular disease‐related mortality and factors associated with cardiovascular events in the TREAT Asia HIV Observational Database (TAHOD)

Cardiovascular disease‐related mortality and factors associated with cardiovascular events in the TREAT Asia HIV Observational Database (TAHOD)

Objectives With aging of the HIV‐positive population, cardiovascular disease (CVD) increasingly contributes to morbidity and mortality. We investigated CVD‐related and other causes of death (CODs) and factors associated with CVD in a multi‐country Asian HIV‐positive cohort. Methods Patient data from...

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Published in:HIV medicine Vol. 20; no. 3; pp. 183 - 191
Main Authors: Bijker, R, Jiamsakul, A, Uy, E, Kumarasamy, N, Ditango, R, Chaiwarith, R, Wong, WW, Avihingsanon, A, Sun, LP, Yunihastuti, E, Pujari, S, Do, CD, Merati, TP, Kantipong, P, Nguyen, KV, Kamarulzaman, A, Zhang, F, Lee, MP, Choi, JY, Tanuma, J, Ng, OT, Sim, BLH, Ross, J, Kiertiburanakul, S, Ly, P. S., Ditangco, R, Cuong, DD, Sohn, AH, Law, MG
Format: Journal Article
Language:English
Published: England 01-03-2019
Subjects:
Adult
Anti-Retroviral Agents - therapeutic use
Asia
Asia - epidemiology
cardiovascular disease
Cardiovascular Diseases - epidemiology
Cardiovascular Diseases - mortality
Cause of Death
Female
HIV
HIV Infections - complications
HIV Infections - drug therapy
Humans
Incidence
Male
Middle Aged
Risk Assessment
Risk Factors
Asia
cardiovascular disease
risk factors
cause of death
HIV
Asia
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Summary:Objectives With aging of the HIV‐positive population, cardiovascular disease (CVD) increasingly contributes to morbidity and mortality. We investigated CVD‐related and other causes of death (CODs) and factors associated with CVD in a multi‐country Asian HIV‐positive cohort. Methods Patient data from 2003–2017 were obtained from the Therapeutics, Research, Education and AIDS Training in Asia (TREAT Asia) HIV Observational Database (TAHOD). We included patients on antiretroviral therapy (ART) with > 1 day of follow‐up. Cumulative incidences were plotted for CVD‐related, AIDS‐related, non‐AIDS‐related, and unknown CODs, and any CVD (i.e. fatal and nonfatal). Competing risk regression was used to assess risk factors of any CVD. Results Of 8069 patients with a median follow‐up of 7.3 years [interquartile range (IQR) 4.4–10.7 years], 378 patients died [incidence rate (IR) 6.2 per 1000 person‐years (PY)], and this total included 22 CVD‐related deaths (IR 0.36 per 1000 PY). Factors significantly associated with any CVD event (IR 2.2 per 1000 PY) were older age [sub‐hazard ratio (sHR) 2.21; 95% confidence interval (CI) 1.36–3.58 for age 41–50 years; sHR 5.52; 95% CI 3.43–8.91 for ≥ 51 years, compared with < 40 years], high blood pressure (sHR 1.62; 95% CI 1.04–2.52), high total cholesterol (sHR 1.89; 95% CI 1.27–2.82), high triglycerides (sHR 1.55; 95% CI 1.02–2.37) and high body mass index (BMI) (sHR 1.66; 95% CI 1.12–2.46). CVD crude IRs were lower in the later ART initiation period and in lower middle‐ and upper middle‐income countries. Conclusions The development of fatal and nonfatal CVD events in our cohort was associated with older age, and treatable risk factors such as high blood pressure, triglycerides, total cholesterol and BMI. Lower CVD event rates in middle‐income countries may indicate under‐diagnosis of CVD in Asian‐Pacific resource‐limited settings.
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ISSN:1464-2662
1468-1293
DOI:10.1111/hiv.12687