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.
This article is protected by copyright. All rights reserved.