R Bijker1, A Jiamsakul1, E Uy2, N Kumarasamy3, R Ditango2, R Chaiwarith4, W W Wong5, A Avihingsanon6, L P Sun7, E Yunihastuti8, S Pujari9, C D Do10, T P Merati11, P Kantipong12, K V Nguyen13, A Kamarulzaman14, F Zhang15, M P Lee16, J Y Choi17, J Tanuma18, O T Ng19, Blh Sim20, J Ross21, S Kiertiburanakul22. 1. The Kirby Institute, University of New South Wales, Sydney, NSW, Australia. 2. Research Institute for Tropical Medicine, Manila, Philippines. 3. YRGCARE Medical Centre, Chennai, India. 4. Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand. 5. Taipei Veterans General Hospital, Taipei, Taiwan. 6. HIV-NAT/The Thai Red Cross AIDS Research Centre, Bangkok, Thailand. 7. National Center for HIV/AIDS, Dermatology & STDs, University of Health Sciences, Phnom Penh, Cambodia. 8. Working Group on AIDS, Faculty of Medicine, University of Indonesia/CiptoMangunkusumo Hospital, Jakarta, Indonesia. 9. Institute of Infectious Diseases, Pune, India. 10. Bach Mai Hospital, Hanoi, Vietnam. 11. Faculty of Medicine, Sanglah Hospital, Udayana University, Bali, Indonesia. 12. Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand. 13. National Hospital for Tropical Diseases, Hanoi, Vietnam. 14. University Malaya Medical Centre, Kuala Lumpur, Malaysia. 15. Beijing Ditan Hospital, Capital Medical University, Bejing, China. 16. Queen Elizabeth Hospital, Kowloon, Hong Kong SAR. 17. Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea. 18. National Center for Global Health and Medicine, Tokyo, Japan. 19. Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore. 20. Hospital Sungai Buloh, Sungai Buloh, Malaysia. 21. TREAT Asia, amfAR - The Foundation for AIDS Research, Bangkok, Thailand. 22. Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Abstract
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.
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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