Oliveira RdVCd, et al. - Researchers performed this study to determine factors associated with the progression of cardiovascular events in people living with HIV (PLHIV) using HAART. As per findings, prolonged use of certain antiretroviral drugs could lead to major cardiovascular events, while low nadir CD4 only affected the occurrence of lipid abnormalities and hypertension. They recommended developing management strategies, including rational use of complex exams (such as, computed-tomography angiography), statins and antihypertensives, based on the distinct roles of antiretroviral use and of HIV infection itself on the progression to cardiovascular events.

Methods

• Researchers conducted a 15-years cohort study with 1135 PLHIV in Rio de Janeiro-Brazil.
• In five states, clinical progression was stratified:
• No comorbidities (s₁),
• arterial hypertension (s₂),
• lipid abnormalities (s₃),
• hypertension and lipid abnormalities (s₄) and
• major cardiovascular events (stroke, coronary artery disease, thrombosis or death) (s₅).
• In Semi-Markov models, the effects of cardiovascular traditional factors, treatment and clinical covariates on transitions between these states were evaluated.
• In this study, Hazard Ratios (HR) and 95% confidence intervals (CI) were provided.

Results

• In patients with low nadir CD4 (<50 cells/mm³), the development of one comorbidity (lipid abnormalities or hypertension) increased in addition to traditional factors (age, sex, educational level and skin color), (HR = 1.59, CI 1.11–2.28 and 1.36, CI 1.11–1.66, respectively).
• With low nadir CD4, the risk to experience a second comorbidity (s₃→s₄) increased by 75%.
• Researchers identified age as the only factor that increased the risk of major cardiovascular events once having lipid abnormalities with or without hypertension (s₃,s₄→s₅).
• Findings revealed that the prolonged use of certain antiretroviral drugs (abacavir, didanosine, ritonavir, lopinavir, amprenavir and fosamprenavir) increased the risk of direct transition (s₁→s₅) to major cardiovascular events (HR = 5.29, CI 1.16–24.05).