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Relative risk of cardiovascular disease among people living with HIV: a systematic review and meta‐analysis

HIV medicine, 2012-09, Vol.13 (8), p.453-468 [Peer Reviewed Journal]

2012 British HIV Association ;2012 British HIV Association. ;ISSN: 1464-2662 ;EISSN: 1468-1293 ;DOI: 10.1111/j.1468-1293.2012.00996.x ;PMID: 22413967

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Title:
Relative risk of cardiovascular disease among people living with HIV: a systematic review and meta‐analysis
Author: Islam, FM ; Wu, J ; Jansson, J ; Wilson, DP
Subjects: Abacavir ; Adult ; Anti-Retroviral Agents - therapeutic use ; antiretroviral therapy ; cardiovascular disease ; Cardiovascular diseases ; Cardiovascular Diseases - epidemiology ; Cardiovascular Diseases - etiology ; Coronary heart disease ; Heart diseases ; HIV ; HIV Infections - complications ; HIV Infections - drug therapy ; Human immunodeficiency virus ; Humans ; Incidence ; Lopinavir ; meta‐analysis ; Myocardial infarction ; Protease Inhibitors - therapeutic use ; Proteinase inhibitors ; relative risk ; Reverse Transcriptase Inhibitors - therapeutic use ; review ; Reviews ; Risk assessment ; Risk Factors ; Ritonavir ; RNA-directed DNA polymerase ; Survival
Is Part Of: HIV medicine, 2012-09, Vol.13 (8), p.453-468
Description: Objectives The aim of this study was to estimate the relative risk of cardiovascular disease (CVD) among people living with HIV (PLHIV) compared with the HIV‐uninfected population. Methods We conducted a systematic review and meta‐analysis of studies from the peer‐reviewed literature. We searched the Medline database for relevant journal articles published before August 2010. Eligible studies were observational and randomized controlled trials, reporting CVD, defined as myocardial infarction (MI), ischaemic heart disease, cardiovascular and cerebrovascular events or coronary heart disease among HIV‐positive adults. Pooled relative risks were calculated for various groupings, including different classes of antiretroviral therapy (ART). Results The relative risk of CVD was 1.61 [95% confidence interval (CI) 1.43–1.81] among PLHIV without ART compared with HIV‐uninfected people. The relative risk of CVD was 2.00 (95% CI 1.70–2.37) among PLHIV on ART compared with HIV‐uninfected people and 1.52 (95% CI 1.35–1.70) compared with treatment‐naïve PLHIV. We estimate the relative risk of CVD associated with protease inhibitor (PI)‐, nucleoside reverse transcriptase inhibitor‐ and nonnucleoside reverse transcriptase inhibitor‐based ART to be 1.11 (95% CI 1.05–1.17), 1.05 (95% CI 1.01–1.10) and 1.04 (95% CI 0.99–1.09) per year of exposure, respectively. Not all ART was associated with increased risk; specifically, lopinavir/ritonavir and abacavir were associated with the greater risk and the relative risk of MI for PI‐based versus non‐PI‐based ART was 1.41 (95% CI 1.20–1.65). Conclusion PLHIV are at increased risk of cardiovascular disease. Although effective in prolonging survival, ART (in particular PI‐based regimens) is related to further increased risk of CVD events among people at highest initial absolute risk of cardiovascular disease.
Publisher: England
Language: English
Identifier: ISSN: 1464-2662
EISSN: 1468-1293
DOI: 10.1111/j.1468-1293.2012.00996.x
PMID: 22413967
Source: IngentaConnect Free/Open Access Journals
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Relative risk of cardiovascular disease among people living with HIV: a systematic review and meta‐analysis

2012 British HIV Association ;2012 British HIV Association. ;ISSN: 1464-2662 ;EISSN: 1468-1293 ;DOI: 10.1111/j.1468-1293.2012.00996.x ;PMID: 22413967

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