There is a paucity of data on cardiovascular disease (CVD) among people living with HIV (PLHIV) in resource-limited countries. We assessed factors associated with CVD and the impact of prevalent CVD on all-cause mortality in PLHIV on antiretroviral therapy in Brazil.
Competing risk-regression to assess factors associated with CVD and all-cause mortality in the HIV-Brazil Cohort Study between 2003-2014.
Among 5,614 patients, the rate of CVD was 3.5 (95% confidence interval [95%CI] 2.9-4.3) per 1,000 person years. CVD was associated with older age (adjusted hazard ratio [aHR] 6.4 for ≥55 years versus <35 years, 95%CI 2.5-16.3, p<0.01), black race (aHR 1.8 versus white race, 95%CI 1.0-3.1, p=0.04), past CVD (aHR 3.0 versus no past CVD, 95%CI 1.4-6.2, p<0.01), hypertension (aHR 1.8 versus no hypertension, 95%CI 1.0-3.1, p=0.04), high-grade dyslipidemia (aHR 9.3 versus no high-grade dyslipidemia, 95%CI 6.0-14.6, p<0.01), ever smoking (aHR 2.4 versus never, 95%CI 1.2-5.0, p=0.02), and low nadir CD4 cell count (aHR 1.8 for 100-250 cells/mm versus >250 cells/mm , 95%CI 1.0-3.2, p=0.05). The rate of death was 16.6 (95%CI 15.1-18.3) per 1,000 person years. Death was strongly associated with having had a past CVD event (aHR 1.7 versus no past CVD event, 95%CI 1.1-2.7, p=0.01).
Traditional and HIV-specific factors associated with CVD among PLHIV in Brazil are similar to those identified among PLHIV in high-income countries. PLHIV in Brazil with a history of CVD have a high risk of death. CVD care and treatment remain priorities for PLHIV in Brazil as this population ages and antiretroviral therapy use expands.

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