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The following is a summary of “Factors Affecting Risk of CVD Events in a Global CVD Prevention Cohort of People with HIV,” published in the April 2025 issue of Clinical Infectious Diseases by Grinspoon et al. 

Researchers conducted a retrospective study to examine the elevated risk of major adverse cardiovascular disease (MACE) among people with HIV (PWH) and the partial risk reduction associated with statin therapy.  

They characterized factors associated with MACE and subcomponents in a global cohort of PWH in REPRIEVE. The primary outcome was time-to-first primary MACE. Secondary outcomes included time-to-first: hard MACE (cardiovascular disease [CVD] death, myocardial infarction [MI], or stroke); MI; and stroke. Cox proportional hazard models were used to estimate the hazard of baseline risk factors for each outcome.  

The results showed that among 7,769 participants, the median age was 50 years (Q1, Q3: 45, 55), with 31% identified as female sex-at-birth, 53% residing in high-income countries (HIC), and a median 10-year PCE ASCVD risk score of 4.5% (2.1, 7.0). In fully adjusted models, the risk of first MACE was higher in individuals aged 50-59 and ≥60 years compared to those aged 40-49, with HRs of 2.06 (95% CI: 1.54, 2.76) and 2.53 (95% CI: 1.60, 4.01), respectively. The increased risk was also observed in Black or African American individuals (vs white race, within HIC, HR: 1.65, 95% CI: 1.19, 2.27), those with a family history of premature cardiovascular disease (HR: 1.53, 95% CI: 1.16, 2.03), current smokers (HR: 2.27, 95% CI: 1.65, 3.13), individuals with hypertension (HR: 1.77, 95% CI: 1.36, 2.30), lower HDL cholesterol (HR: 1.21, 95% CI: 1.10, 1.34), HIV-1 RNA ≥ lower-limit-of-quantification (LLQ) (HR: 1.40, 95% CI: 1.0, 1.97), and those on a specific ART regimen (HR: 1.53, 95% CI: 1.01, 2.31). Individuals from HIC showed a higher risk of first MACE compared to those from other regions, except South Asia. No protective effect of female sex was noted. Modeling for hard MACE, MI, and stroke provided generally similar results for most variables.  

Investigators concluded that among PWH in REPRIEVE, modifiable risk factors for first MACE, after accounting for statin effects, included cigarette smoking, hypertension, lower HDL cholesterol, and HIV-1 RNA ≥LLQ, with no protective effect of female sex.

Source: academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaf210/8120235