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Global burden of HIV-related CVD on the rise
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The global burden of CVD associated with HIV has tripled in the past 2 decades, with the greatest burden in Asia-Pacific and sub-Saharan Africa regions, according to a review published in Circulation.
“To date, most of the literature in this field has focused on high-income countries such as the United States and European countries, but when you think about where the population of people living with HIV actually live, it’s in the low-income countries of sub-Saharan Africa,” Chris T. Longenecker, MD, assistant professor of medicine at Case Western Reserve University in Cleveland and Cardiology Today Next Gen Innovator, said in an interview. “This study attempted to estimate the global burden and show that there may be a lot of cardiovascular disease due to HIV that’s occurring in Africa and we hardly know anything about that.”
Anoop S.V. Shah, MD, MPH, PhD, clinical lecturer in cardiology at University of Edinburgh in Scotland, and colleagues analyzed data of 793,635 patients with HIV from 80 longitudinal studies. These data were used to estimate the risk ratio and rate of CVD. The pooled crude incident rates of fatal and nonfatal CVD were also calculated from 122 estimates from 73 studies.
Other data used in this review included regional and global estimates of CVD caused by HIV, national disability-adjusted life-year estimates for CVD and prevalence estimates for HIV.
During 3.5 million person-years of follow-up, the crude incidence rate for CVD was 61.8 per 10,000 person-years (95% CI, 45.8-83.4). The risk ratio for CVD in patients with HIV was 2.16 vs. those without HIV (95% CI, 1.68-2.77).
The global population attributable fraction for CVD in patients with HIV increased from 0.36% in 1990 (95% CI, 0.21-0.56) to 0.92% in 2015 (95% CI, 0.55-1.41). During this time, DALYs also increased from 0.74 million (95% CI, 0.44-1.16) to 2.57 million (95% CI, 1.53-3.92).
The highest proportion of DALYs lost was in the sub-Saharan African (0.87 million; 95% CI, 0.43-1.7) and Asia-Pacific regions (0.39 million; 95% CI, 0.23-0.62).
Swaziland, Lesotho and Botswana had the highest population-attributable fraction and burden.
“The implications of this study are primarily for policymakers, for governments around the world and for nongovernmental organizations, funding agencies and [other organizations] to show that we need to do more research on cardiovascular disease among people living with HIV in the places where the burden is highest,” Longenecker told Cardiology Today. – by Darlene Dobkowski
For more information:
Chris Longenecker, MD, can be reached at 11100 Euclid Ave., Cleveland, OH 44106; email: chris.longenecker@uhhospitals.org.
Disclosures: The authors report no relevant financial disclosures.
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