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03/04/2013

CROI 2013: More evidence for higher risk of cardiovascular disease among HIV-positives


Several studies have found an elevated risk of cardiovascular disease and certain non-HIV related cancers among HIV-positive individuals. But the age of onset of comorbidities remains controversial, with some studies finding an earlier age of onset, while others have determined that the apparent younger age of onset is an artifact of the underlying younger age distribution of persons who are HIV infected. Determining whether HIV-positive individuals have an earlier onset of comorbidities has important consequences for screening guidelines. Keri Althoff from Washington, DC, provided more evidence on this topic today using data from the Veterans Aging Cohort Study. She and her co-authors investigated rates of incident cardiovascular disease, non-AIDS-defining cancers and end-stage renal disease as well as age of onset of these comorbidities among HIV-infected and uninfected clients. Two HIV-negative participants were matched to one HIV positive client on the basis of age, sex, race and clinical site of care. An important feature of this study was the ability to adjust for potential confounders, such as tobacco use, body mass index, hyperlipidemia and Hepatitis C. The age of diagnosis for myocardial infarction, cancer or end stage renal disease was not significantly different between HIV positive and negative participants, however an increased risk of events was noted for HIV positive persons for all three conditions. The highest risk was found for cardiovascular disease where an 81% increase in risk was noted for HIV-positive individuals (adjusted incidence rate ratio IRR 1.81 [95% CI: 1.49, 2.20]). The study underscored the need to aggressively screen and treat identified modifiable risk factors among HIV-infected clients.

References:
1. DAD Study Group. N Engl J Med. 2003; 349(21):1993-2003.
2. Lichtenstein, K. Clin Infect Dis. (2010) 51 (4): 435-447.
3. Althoff K, Wyatt C, Gibert C, Oursler KA, Rimland D, Rodriguez-Barradas M, McGinnis K, Skanderson M, Gebo K, Justice A. HIV+ Adults Are at Greater Risk for Myocardial Infarction, Non-AIDS Cancer, and End-stage Renal Disease, but Events Occur at Similar Ages Compared to HIV– Adults. Presented March 4, 2013 at the 20th CROI, Atlanta, GA. Oral Abstract #59


Source: Reporting from Atlanta for PRN News: Anita Radix, MD, MPH