Low use of CVD prevention strategies in people with HIV

There is an underutilization of cardiovascular disease (CVD) prevention strategies in people living with HIV (PLHIV) who are at risk of CVD, according to a study presented at HIV Glasgow 2022.

A total of 5,720 adults (median age 55 years, 87.9 percent male, 82.5 percent White) with a very high risk for CVD (>10 percent estimated 10-year risk) were identified from the multinational RESPOND cohort. Patients with a history of CVD were excluded.

Median CD4 cell count at baseline was 560 cells/mm³. Sixty-three percent of patients had dyslipidaemia, 38.7 percent hypertension, and 15.3 percent diabetes. About 58 percent were current smokers and 9.3 percent were obese (BMI >30 kg/m²). The most common antiretroviral therapy (ART) used in this group was abacavir (52.1 percent), while 36.6, 33.6, and 18.4 percent were exposed to lopinavir, indinavir, and darunavir, respectively.

The proportion of patients with a very high CVD risk increased between 2012 and 2019 (from 31.5 percent to 49.0 percent). [HIV Glasgow 2022, abstract O22]

There was a significant reduction in the use of antidiabetic treatments between 2012 and 2019 (from 63.5 percent to 57.1 percent; p=0.008). The use of antihypertensives (from 68.3 percent to 66.0 percent; p=0.23) and angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs; from 42.7 percent to 42.2 percent; p=0.28) did not significantly differ between 2012 and 2019, but there was a non-significant increase in the use of lipid-lowering drugs (LLDs; from 51.1 percent to 56.8 percent; p=0.58).

Between 2012 and 2019, there was a non-significant reduction in the proportion of patients who quit smoking (from 9.4 percent to 7.7 percent; p=0.94) and in the proportion of patients with obesity who experienced weight loss of ≥7 percent (from 11.5 percent to 10.5 percent; p=0.05).

However, discontinuation of ART associated with CVD – lopinavir, darunavir, abacavir – for >6 months increased between 2012 and 2019 (lopinavir: from 15.2 percent to 26.7 percent; darunavir: from 7.5 percent to 12.1 percent; abacavir: from 2.5 percent to 7.7 percent; p<0.001 for all).

Older individuals (age ≥50 years for women, ≥40 years for men) were more likely to use antihypertensives, ACE inhibitors and/or ARBs, antidiabetics, or LLDs compared with younger individuals (adjusted odds ratios [adjORs], 1.57, 1.49, 1.64, and 1.74, respectively). Patients with diabetes were more likely to use antihypertensives or LLDs than those without diabetes (adjORs, 1.93 and 2.03, respectively). LLD use was less common in patients with intravenous drug use (IDU) as HIV acquisition risk (adjOR, 0.60 vs non-IDU) and in patients with viraemia (viral load >200 copies/mL; adjOR, 0.51 vs <200 copies/mL), as was smoking cessation (adjORs, 0.66 and 0.65, respectively). However, patients with diabetes were more likely to quit smoking (adjOR, 1.32).

Use of CVD prevention therapies was similar in men and women, though women were less likely to use ACE inhibitors and/or ARBs (adjOR, 0.73 vs men).

The prolonged life expectancy of PLHIV has been accompanied by an increase in the prevalence of non-AIDS comorbidities, such as CVD, said study author Dr Nadine Jaschinski from Rigshospitalet and University of Copenhagen, Copenhagen, Denmark. However, CVD risk prevention and management strategies in this population have been suboptimal, she added.

The results of this study showed that CVD preventive measures were still underutilized despite an increase in the proportion of patients at very high estimated risk of CVD between 2012 and 2019.

Jaschinski acknowledged the potential for residual confounding due to inadequate information on certain potentially influential factors (eg, family history of CVD) or adherence to prevention strategies. In addition, discontinuation of ARTs may have been for non-CVD reasons, she added.

“Overall, our findings call for greater awareness of management guidelines for CVD risk factors in PLHIV,” said Jaschinski.