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Associations between HIV viremia during antiretroviral therapy and cardiovascular disease

Elvstam, Olof LU orcid ; Marrone, Gaetano LU ; Engström, Gunnar LU ; Nilsson, Peter M LU ; Carlander, Christina ; Treutiger, Carl Johan ; Gisslén, Magnus and Björkman, Per LU orcid (2022) In AIDS (London, England) 36(13). p.1829-1834
Abstract

OBJECTIVE: To investigate the association between HIV viremia exposure during antiretroviral therapy (ART) and cardiovascular disease (CVD) risk.

DESIGN: Nationwide observational cohort.

METHODS: Participants (age > 15 years) from the Swedish nationwide InfCareHIV register initiating ART 1996-2017 were categorized in a time-updated manner into four viremia categories, starting from 12 months after ART initiation: suppression (<50 copies/ml), low-level viremia (50-199 copies/ml and 200-999 copies/ml, respectively), and high-level viremia (≥1000 copies/ml). In addition, cumulative viremia was estimated as the area under the log viral load (VL) curve. Proportional subhazard models adjusted for sex, age, pre-ART CD4 and... (More)

OBJECTIVE: To investigate the association between HIV viremia exposure during antiretroviral therapy (ART) and cardiovascular disease (CVD) risk.

DESIGN: Nationwide observational cohort.

METHODS: Participants (age > 15 years) from the Swedish nationwide InfCareHIV register initiating ART 1996-2017 were categorized in a time-updated manner into four viremia categories, starting from 12 months after ART initiation: suppression (<50 copies/ml), low-level viremia (50-199 copies/ml and 200-999 copies/ml, respectively), and high-level viremia (≥1000 copies/ml). In addition, cumulative viremia was estimated as the area under the log viral load (VL) curve. Proportional subhazard models adjusted for sex, age, pre-ART CD4 and VL, injection drug use, and country of birth were used to analyze the association between viremia exposure and CVD risk (ischemic heart disease, stroke, and heart failure; data obtained by linkage to national registers), accounting for the competing risk of non-CVD death.

RESULTS: In all, 337 cases of CVD were observed during 44 937 person-years of follow-up (n = 6562). Higher viremia exposure was associated with CVD, both when parameterized as cumulative viremia (adjusted subhazard ratio [aSHR] per 1 log10 copy × year/ml, 1.03; 95% confidence interval [CI], 1.01-1.05) and as viremia category (aSHR for high-level viremia versus suppression, 1.45; 95% CI, 1.03-2.05). We observed no association between CVD and low-level viremia compared with those with suppression.

CONCLUSIONS: Higher exposure to HIV viremia was linked to CVD in ART recipients, whereas no increased risk was detected for people with low-level viremia compared with viral suppression. Causal inference is limited by the observational nature of this study.

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author
; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
AIDS (London, England)
volume
36
issue
13
pages
6 pages
publisher
Lippincott Williams & Wilkins
external identifiers
  • pmid:35730359
  • scopus:85139375688
ISSN
1473-5571
DOI
10.1097/QAD.0000000000003240
language
English
LU publication?
yes
additional info
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
id
50ad10bf-1d6a-479c-8301-2fc96a7889c6
date added to LUP
2022-06-30 10:02:27
date last changed
2025-10-18 20:46:13
@article{50ad10bf-1d6a-479c-8301-2fc96a7889c6,
  abstract     = {{<p>OBJECTIVE: To investigate the association between HIV viremia exposure during antiretroviral therapy (ART) and cardiovascular disease (CVD) risk.</p><p>DESIGN: Nationwide observational cohort.</p><p>METHODS: Participants (age &gt; 15 years) from the Swedish nationwide InfCareHIV register initiating ART 1996-2017 were categorized in a time-updated manner into four viremia categories, starting from 12 months after ART initiation: suppression (&lt;50 copies/ml), low-level viremia (50-199 copies/ml and 200-999 copies/ml, respectively), and high-level viremia (≥1000 copies/ml). In addition, cumulative viremia was estimated as the area under the log viral load (VL) curve. Proportional subhazard models adjusted for sex, age, pre-ART CD4 and VL, injection drug use, and country of birth were used to analyze the association between viremia exposure and CVD risk (ischemic heart disease, stroke, and heart failure; data obtained by linkage to national registers), accounting for the competing risk of non-CVD death.</p><p>RESULTS: In all, 337 cases of CVD were observed during 44 937 person-years of follow-up (n = 6562). Higher viremia exposure was associated with CVD, both when parameterized as cumulative viremia (adjusted subhazard ratio [aSHR] per 1 log10 copy × year/ml, 1.03; 95% confidence interval [CI], 1.01-1.05) and as viremia category (aSHR for high-level viremia versus suppression, 1.45; 95% CI, 1.03-2.05). We observed no association between CVD and low-level viremia compared with those with suppression.</p><p>CONCLUSIONS: Higher exposure to HIV viremia was linked to CVD in ART recipients, whereas no increased risk was detected for people with low-level viremia compared with viral suppression. Causal inference is limited by the observational nature of this study.</p>}},
  author       = {{Elvstam, Olof and Marrone, Gaetano and Engström, Gunnar and Nilsson, Peter M and Carlander, Christina and Treutiger, Carl Johan and Gisslén, Magnus and Björkman, Per}},
  issn         = {{1473-5571}},
  language     = {{eng}},
  month        = {{06}},
  number       = {{13}},
  pages        = {{1829--1834}},
  publisher    = {{Lippincott Williams & Wilkins}},
  series       = {{AIDS (London, England)}},
  title        = {{Associations between HIV viremia during antiretroviral therapy and cardiovascular disease}},
  url          = {{http://dx.doi.org/10.1097/QAD.0000000000003240}},
  doi          = {{10.1097/QAD.0000000000003240}},
  volume       = {{36}},
  year         = {{2022}},
}