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- Title
Relative risk of cardiovascular disease among people living with HIV: a systematic review and meta-analysis.
- Authors
Islam, FM; Wu, J; Jansson, J; Wilson, DP
- Abstract
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.
- Subjects
THERAPEUTIC use of protease inhibitors; ANTIRETROVIRAL agents; CARDIOVASCULAR diseases; CONFIDENCE intervals; HIV infections; MEDLINE; META-analysis; PROBABILITY theory; RESEARCH funding; SYSTEMATIC reviews; LOGISTIC regression analysis; HIGHLY active antiretroviral therapy; RELATIVE medical risk; DATA analysis software; CD4 lymphocyte count
- Publication
HIV Medicine, 2012, Vol 13, Issue 8, p453
- ISSN
1464-2662
- Publication type
Article
- DOI
10.1111/j.1468-1293.2012.00996.x