Risk of cardiovascular disease in HIV-positive Queensland men receiving combined antiretroviral therapy
Luis Furuya-Kanamori A D , Mark D. Kelly B C and Samantha J. McKenzie A
+ Author Affiliations
- Author Affiliations
A The University of Queensland, School of Population Health, Herston Road, Herston, Qld 4006, Australia.
B Brisbane Sexual Health and HIV Service, 270 Roma Street, Brisbane, Qld 4000, Australia.
C Present address: John Hunter Hospital, Lookout Road, New Lambton, NSW 2305, Australia.
D Corresponding author. Email: luis.furuyakanamori@uqconnect.edu.au
Sexual Health 12(4) 348-352 https://doi.org/10.1071/SH14062
Submitted: 31 March 2014 Accepted: 10 April 2015 Published: 1 June 2015
Abstract
Background: Cardiovascular disease (CVD) is a major cause of death among HIV-positive individuals receiving combination antiretroviral therapy (cART). The risk of CVD is estimated using a variety of risk calculations, however, currently there is no specific CVD risk calculator endorsed for Australians receiving cART. Methods: A retrospective study of 210 Queensland men older than 35 years with cART-treated HIV was conducted to estimate the prevalence of CVD and the risk of a cardiovascular event occurring within 5 years. The weighted Cohen’s kappa coefficient was used to estimate the agreement between the Australian Absolute CVD Risk Calculator and the Data Collection on Adverse Effects of Anti-HIV Drugs Study (D:A:D) 5-year Estimated CVD Risk Equation. Results: The prevalence of CVD was 31.9%. Hypertensive disease was the most prevalent CVD (25.2%). Queensland men with cART-treated HIV were at moderate risk (5%) of a cardiovascular event in the next 5 years. There was a substantial agreement (κ = 0.63) between the Australian Absolute CVD Risk Calculator and the D:A:D 5-year Estimated CVD Risk Equation. Conclusions: Queensland men with cART-treated HIV are experiencing high prevalence of CVD and are at moderate risk of a CVD event in the next 5 years. Primary care guidelines should emphasise CVD prevention as a keystone for the treatment of people living with HIV.
References
[1] The Kirby Institute. HIV, viral hepatitis and sexually transmissible infections in Australia annual surveillance report 2013. Sydney: The Kirby Institute, University of New South Wales; 2013.[2] Frederic P, Miller AFV, McBrewster J. Socialized medicine: socialized medicine. Health care in Australia, health care in Canada, healthcare in Cuba, healthcare in Finland, health care in Israel, health in Russia. Beau-Bassin: Alphascript Publishing; 2009.
[3] Antiretroviral Therapy Cohort Collaboration Life expectancy of individuals on combination antiretroviral therapy in high-income countries: a collaborative analysis of 14 cohort studies. Lancet 2008; 372 293–9.
| Life expectancy of individuals on combination antiretroviral therapy in high-income countries: a collaborative analysis of 14 cohort studies.Crossref | GoogleScholarGoogle Scholar | 18657708PubMed |
[4] Aldaz P, Moreno-Iribas C, Egues N, Irisarri F, Floristan Y, Sola-Boneta J, Martinez-Artola V, Sagredo M, Castilla J. Mortality by causes in HIV-infected adults: comparison with the general population. BMC Public Health 2011; 11 300
| Mortality by causes in HIV-infected adults: comparison with the general population.Crossref | GoogleScholarGoogle Scholar | 21569323PubMed |
[5] Deeks SG, Phillips AN. HIV infection, antiretroviral treatment, ageing, and non-AIDS related morbidity. BMJ 2009; 338 a3172
| HIV infection, antiretroviral treatment, ageing, and non-AIDS related morbidity.Crossref | GoogleScholarGoogle Scholar | 19171560PubMed |
[6] Guaraldi G, Orlando G, Zona S, Menozzi M, Carli F, Garlassi E, Berti A, Rossi E, Roverato A, Palella F. Premature age-related comorbidities among HIV-infected persons compared with the general population. Clin Infect Dis 2011; 53 1120–6.
| Premature age-related comorbidities among HIV-infected persons compared with the general population.Crossref | GoogleScholarGoogle Scholar | 21998278PubMed |
[7] Shiels MS, Pfeiffer RM, Engels EA. Age at cancer diagnosis among persons with AIDS in the United States. Ann Intern Med 2010; 153 452–60.
| Age at cancer diagnosis among persons with AIDS in the United States.Crossref | GoogleScholarGoogle Scholar | 20921544PubMed |
[8] Freiberg MS, Chang CC, Kuller LH, Skanderson M, Lowy E, Kraemer KL, Butt AA, Goetz M, Leaf D, Oursler KA, Rimland D, Rodriguez-Barradas M, Brown S, Gibert C, McGinnis K, Crothers K, Sico J, Crane H, Warner A, Gottlieb S, Gottdiener J, Tracy RP, Budoff M, Watson C, Armah KA, Doebler D, Bryant K, Justice AC. HIV Infection and the Risk of Acute Myocardial Infarction. JAMA Intern Med 2013; 173 614–22.
| 1:CAS:528:DC%2BC3sXntVaht74%3D&md5=5752bfec760f2c227d936c0f060bf0caCAS | 23459863PubMed |
[9] Althoff KN, Wyatt C, Gibert C, Ourslet KA, Rimland D, Rodriguez-Barradas M, McGinnis K, Skanderson M, Gebo K, Justice AC. HIV-infected adults are at greater risk for myocardial infarction, end-stage renal disease, and non-AIDS-defining cancers, but events occur at similar ages compared to HIV-uninfected adults. 20th Conference on Retroviruses and Opportunistic Infections. Atlanta; 2013. Available online at: http://www.natap.org/2013/CROI/croi_62.htm [verified April 2015].
[10] Furuya-Kanamori L, Kelly MD, McKenzie SJ. Comorbidity, ageing and predicted mortality in antiretroviral treated Australian men: a quantitative analysis. PLoS One 2013; 8 e78403
| Comorbidity, ageing and predicted mortality in antiretroviral treated Australian men: a quantitative analysis.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3sXhslWksL7O&md5=19e78b79aac51227ee75f80c25c7a8c1CAS | 24205222PubMed |
[11] Australian Institute of Health Welfare and National Centre for Monitoring Cardiovascular Disease. Cardiovascular disease: Australian facts 2011. Canberra: Australian Institute of Health and Welfare; 2011.
[12] Antiretroviral Therapy Cohort Collaboration Causes of death in HIV-1-infected patients treated with antiretroviral therapy, 1996–2006: collaborative analysis of 13 HIV cohort studies. Clin Infect Dis 2010; 50 1387–96.
| Causes of death in HIV-1-infected patients treated with antiretroviral therapy, 1996–2006: collaborative analysis of 13 HIV cohort studies.Crossref | GoogleScholarGoogle Scholar | 20380565PubMed |
[13] National Vascular Disease Prevention Alliance. Technical report: review of the evidence and evidence-based recommendations for practice. 2009. Available online at: https://www.diabetesaustralia.com.au/PageFiles/9158/A_AR_TechReport_FINAL.pdf [verified April 2015].
[14] Friis-Moller N, Thiebaut R, Reiss P, Weber R, D’Arminio Monforte A, De Wit S, El-Sadr W, Fontas E, Worm S, Kirk O, Phillips A, Sabin CA, Lundgren JD, Law MG. Predicting the risk of cardiovascular disease in HIV-infected patients: the data collection on adverse effects of anti-HIV drugs study. Eur J Cardiovasc Prev Rehabil 2010; 17 491–501.
| Predicting the risk of cardiovascular disease in HIV-infected patients: the data collection on adverse effects of anti-HIV drugs study.Crossref | GoogleScholarGoogle Scholar | 20543702PubMed |
[15] Wilson PW, D’Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB. Prediction of coronary heart disease using risk factor categories. Circulation 1998; 97 1837–47.
| Prediction of coronary heart disease using risk factor categories.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1c3msVOjsA%3D%3D&md5=b9733362988bbb99e6d1c273e727628eCAS | 9603539PubMed |
[16] Law MG, Friis-Moller N, El-Sadr WM, Weber R, Reiss P, D’Arminio Monforte A, Thiebaut R, Morfeldt L, De Wit S, Pradier C, Calvo G, Kirk O, Sabin CA, Phillips AN, Lundgren JD. The use of the Framingham equation to predict myocardial infarctions in HIV-infected patients: comparison with observed events in the D:A:D Study. HIV Med 2006; 7 218–30.
| The use of the Framingham equation to predict myocardial infarctions in HIV-infected patients: comparison with observed events in the D:A:D Study.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD283itlOquw%3D%3D&md5=29873d6e10e09f73c045d58cfe5fe086CAS | 16630034PubMed |
[17] Carr A, Samaras K, Burton S, Law M, Freund J, Chisholm DJ, Cooper DA. A syndrome of peripheral lipodystrophy, hyperlipidaemia and insulin resistance in patients receiving HIV protease inhibitors. AIDS 1998; 12 F51–8.
| A syndrome of peripheral lipodystrophy, hyperlipidaemia and insulin resistance in patients receiving HIV protease inhibitors.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1c3otFSqtQ%3D%3D&md5=0746192ac639e7b799ce5d4bc4d318a8CAS | 9619798PubMed |
[18] Nolan D, Mallal S. Getting to the HAART of insulin resistance. AIDS 2001; 15 2037–41.
| Getting to the HAART of insulin resistance.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD3MXotlCltrc%3D&md5=5b887e1aaa4cb9d97fc56cd7ac1a1356CAS | 11600834PubMed |
[19] Copenhagen HIV Programme. D:A:D Risk Equations; 2012. Available online at: http://hivpv.org/Home/Tools/tabid/91/ctl/ExamView/mid/500/eid/0/lid/0/Default.aspx [verified April 2015].
[20] National Vascular Disease Prevention Alliance. Australian absolute cardiovascular disease risk calculator – National Vascular Disease Prevention Alliance; 2012. Available online at: http://www.cvdcheck.org.au/ [verified April 2015].
[21] Friis-Moller N, Weber R, Reiss P, Thiebaut R, Kirk O, D’Arminio , Monforte A, Pradier C, Morfeldt L, Mateu S, Law M, El-Sadr W, De Wit S, Sabin CA, Phillips AN, Lundgren JD. Cardiovascular disease risk factors in HIV patients – association with antiretroviral therapy. Results from the D:A:D study. AIDS 2003; 17 1179–93.
| Cardiovascular disease risk factors in HIV patients – association with antiretroviral therapy. Results from the D:A:D study.Crossref | GoogleScholarGoogle Scholar | 12819520PubMed |
[22] Melzi S, Carenzi L, Cossu MV, Passerini S, Capetti A, Rizzardini G. Lipid metabolism and cardiovascular risk in HIV-1 infection and HAART: present and future problems. Cholesterol 2010; 2010 271504
| Lipid metabolism and cardiovascular risk in HIV-1 infection and HAART: present and future problems.Crossref | GoogleScholarGoogle Scholar | 21490912PubMed |
[23] Muhammad S, Sani MU, Okeahialam BN. Prevalence of dyslipidemia among human immunodeficiency virus infected Nigerians. Ann Afr Med 2013; 12 24–8.
| Prevalence of dyslipidemia among human immunodeficiency virus infected Nigerians.Crossref | GoogleScholarGoogle Scholar | 23480991PubMed |
[24] Palella FJ,, Phair JP. Cardiovascular disease in HIV infection. Curr Opin HIV AIDS 2011; 6 266–71.
| Cardiovascular disease in HIV infection.Crossref | GoogleScholarGoogle Scholar |
[25] Currier JS, Lundgren JD, Carr A, Klein D, Sabin CA, Sax PE, Schouten JT, Smieja M. Epidemiological evidence for cardiovascular disease in HIV-infected patients and relationship to highly active antiretroviral therapy. Circulation 2008; 118 e29–35.
| Epidemiological evidence for cardiovascular disease in HIV-infected patients and relationship to highly active antiretroviral therapy.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD1cXoslClu7Y%3D&md5=1578ee2328f48f873446a4ba983c8593CAS | 18566319PubMed |
[26] Writing Group Members Heart disease and stroke statistics—2012 update: a report from the American Heart Association. Circulation 2012; 125 e2–220.
| Heart disease and stroke statistics—2012 update: a report from the American Heart Association.Crossref | GoogleScholarGoogle Scholar | 22179539PubMed |
[27] Cohen J. A coefficient of agreement for nominal scales. Educ Psychol Meas 1960; 20 37–46.
| A coefficient of agreement for nominal scales.Crossref | GoogleScholarGoogle Scholar |
[28] Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33 159–74.
| The measurement of observer agreement for categorical data.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaE2s7jsFWqtA%3D%3D&md5=441112343d17f0baf6aebd5bdc946d78CAS | 843571PubMed |
[29] Passing H, Bablok W. A new biometrical procedure for testing the equality of measurements from two different analytical methods. Application of linear regression procedures for method comparison studies in clinical chemistry. J Clin Chem Clin Biochem 1983; 21 709–20.
| 1:STN:280:DyaL2c%2FovFGgtQ%3D%3D&md5=d12ed266ee0dbc27e4b22a88ef95232eCAS | 6655447PubMed |
[30] Australian Institute of Health and Welfare. Australia’s health 2010. Canberra: Australian Institute of Health and Welfare; 2010.
[31] Mallon PG. Getting to the heart of HIV and myocardial infarction: comment on “HIV infection and the risk of acute myocardial infarction”. J Am Med Assoc Int Med 2013; 1–2.
[32] Australian Institute of Health and Welfare. 2007 National Drug Strategy Household Survey. Canberra: Australian Institute of Health and Welfare; 2008.
[33] Feeney ER, Mallon PW. Insulin resistance in treated HIV infection. Best Pract Res Clin Endocrinol Metab 2011; 25 443–58.
| Insulin resistance in treated HIV infection.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3MXnsVWnu7s%3D&md5=b587e601bf6f085d5d99a7716d04c47eCAS | 21663838PubMed |
[34] Bhavan KP, Kampalath VN, Overton ET. The aging of the HIV epidemic. Curr HIV/AIDS Rep 2008; 5 150–8.
| The aging of the HIV epidemic.Crossref | GoogleScholarGoogle Scholar | 18627664PubMed |
[35] Simone MJ, Appelbaum J. HIV in older adults. Geriatrics 2008; 63 6–12.
| 19061274PubMed |
[36] Petoumenos K, Worm S, Reiss P, De Wit S, D’Arminio Monforte A, Sabin C, Friis-Moller N, Weber R, Mercie P, Pradier C, El-Sadr W, Kirk O, Lundgren J, Law MG. Rates of cardiovascular disease following smoking cessation in patients with HIV infection: results from the D:A:D study HIV Med 2011; 12 412–21.
| Rates of cardiovascular disease following smoking cessation in patients with HIV infection: results from the D:A:D studyCrossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC3MjnsVGksA%3D%3D&md5=cc76849ca716787e1d2e3621148b69c5CAS | 21251183PubMed |
[37] The Queensland Government. Queensland HIV clinicians clinical guidance algorithm for reduction of cardiovascular risk in patients with HIV. 2012. Available online at: https://www.sugarsync.com/pf/D2482576_90916532_6124431 [verified April 2015].
