Control of risk factors such as dyslipidemia and diabetes reduces the association between cardiovascular disease and HIV, new research shows.

Control of dyslipidemia and diabetes, but not hypertension, reduces the association of HIV status with cardiovascular disease (CVD), according to a study published in Clinical Infectious Diseases. Michael J. Silverberg, PhD, MPH, from Kaiser Permanente Northern California, and colleagues conducted a retrospective cohort study involving 8,285 people with HIV (PWH) and 170,517 people without HIV (PWoH) from an integrated health system. The study team measured control of risk factors, including hypertension, dyslipidemia, diabetes, and other modifiable factors, using a novel disease management index (DMI), accounting for amount/duration above treatment goals (0%-100% [perfect control]). PWH and PWoH had similar DMIs (80%-100%) apart from triglycerides, which was worse for PWH, and hemoglobin A1c, which was better for PWH. When compared with PWoH, PWH had an increased risk for CVD in adjusted models (HR, 1.18). In subgroups with controlled dyslipidemia and diabetes, the association was attenuated; however, it remained elevated for PWH with controlled hypertension or higher total cholesterol. The subgroup with frequent unhealthy alcohol use had the strongest HIV status association with CVD (HR, 2.13).