Institute for Health Policy Studies, University of California, San Francisco, CA, USA.
Kirby Institute, University of New South Wales, Sydney, Australia.
Trop Med Int Health. 2020 Jul;25(7):886-896. doi: 10.1111/tmi.13405. Epub 2020 May 11.
There is a paucity of data on cardiovascular disease (CVD) among people living with HIV (PLHIV) in resource-limited countries. We assessed factors associated with CVD and the impact of prevalent CVD on all-cause mortality in PLHIV on antiretroviral therapy in Brazil.
Competing risk regression to assess factors associated with CVD and all-cause mortality in the HIV-Brazil Cohort Study between 2003 and 2014.
Among 5614 patients, the rate of CVD was 3.5 (95% confidence interval [95% CI] 2.9-4.3) per 1000 person-years. CVD was associated with older age (adjusted hazard ratio [aHR] 6.4 for ≥55 years vs. <35 years, 95% CI: 2.5-16.3, P < 0.01), black race (aHR 1.8 vs. white race, 95% CI: 1.0-3.1, P = 0.04), past CVD (aHR 3.0 vs. no past CVD, 95% CI: 1.4-6.2, P < 0.01), hypertension (aHR 1.8 vs. no hypertension, 95% CI: 1.0-3.1, P = 0.04), high-grade dyslipidemia (aHR 9.3 vs. no high-grade dyslipidemia, 95% CI: 6.0-14.6, P < 0.01), ever smoking (aHR 2.4 vs. never, 95% CI: 1.2-5.0, P = 0.02) and low nadir CD4 cell count (aHR 1.8 for 100-250 cells/mm vs. >250 cells/mm , 95% CI: 1.0-3.2, P = 0.05). The rate of death was 16.6 (95% CI: 15.1-18.3) per 1000 person-years. Death was strongly associated with having had a past CVD event (aHR 1.7 vs. no past CVD event, 95% CI: 1.1-2.7, P = 0.01).
Traditional and HIV-specific factors associated with CVD among PLHIV in Brazil are similar to those identified among PLHIV in high-income countries. PLHIV in Brazil with a history of CVD have a high risk of death. CVD care and treatment remain priorities for PLHIV in Brazil as this population ages and antiretroviral therapy use expands.
资源有限国家中，针对艾滋病毒感染者（PLHIV）的心血管疾病（CVD）数据较为匮乏。我们评估了与 CVD 相关的因素，以及在巴西接受抗逆转录病毒治疗的 PLHIV 中，现患 CVD 对全因死亡率的影响。
采用竞争风险回归分析方法，评估了 2003 年至 2014 年期间 HIV-Brazil 队列研究中与 CVD 和全因死亡率相关的因素。
在 5614 例患者中，CVD 的发生率为每 1000 人年 3.5 例（95%置信区间[95%CI]为 2.9-4.3）。CVD 与年龄较大（调整后的危险比[aHR]，≥55 岁与＜35 岁，95%CI：2.5-16.3，P＜0.01）、黑种人（aHR 1.8 与白种人，95%CI：1.0-3.1，P=0.04）、既往 CVD（aHR 3.0 与无既往 CVD，95%CI：1.4-6.2，P＜0.01）、高血压（aHR 1.8 与无高血压，95%CI：1.0-3.1，P=0.04）、重度血脂异常（aHR 9.3 与无重度血脂异常，95%CI：6.0-14.6，P＜0.01）、曾吸烟（aHR 2.4 与从不吸烟，95%CI：1.2-5.0，P=0.02）和 CD4 细胞最低计数较低（aHR 1.8，100-250 个/毫米与＞250 个/毫米，95%CI：1.0-3.2，P=0.05）相关。死亡率为每 1000 人年 16.6 例（95%CI：15.1-18.3）。既往 CVD 事件与死亡显著相关（aHR 1.7 与无既往 CVD 事件，95%CI：1.1-2.7，P=0.01）。
巴西 PLHIV 中与 CVD 相关的传统和 HIV 特异性因素与高收入国家的 PLHIV 中确定的因素相似。在巴西，有 CVD 病史的 PLHIV 死亡风险较高。随着该人群年龄增长和抗逆转录病毒治疗的应用扩大，CVD 的治疗和管理仍是巴西 PLHIV 的重点。
