Associations between HIV viremia during antiretroviral therapy and cardiovascular disease
(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
- Elvstam, Olof LU ; Marrone, Gaetano LU ; Engström, Gunnar LU ; Nilsson, Peter M LU ; Carlander, Christina ; Treutiger, Carl Johan ; Gisslén, Magnus and Björkman, Per LU
- organization
- publishing date
- 2022-06-23
- 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
-
- scopus:85139375688
- pmid:35730359
- 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
- 2024-09-19 22:01:46
@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 > 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.</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}}, }