Viremia Does Not Independently Predict Cardiovascular Disease in People With HIV: A RESPOND Cohort Study
People living with HIV (PWHIV) have a higher risk of developing cardiovascular disease (CVD) compared with the general population. One possible reason is HIV viremia. The aim of this study was to examine whether HIV viremia is independently associated with the development of CVD after adjusting for established CVD risk factors.
The researchers used data from RESPOND, a large international collaboration that includes people with HIV from 19 cohorts across Europe and Australia. Adults were followed from the first date when complete clinical data were available until they experienced a CVD event, were lost to follow-up, died, or reached the end of the study period. The main outcome was a composite measure of cardiovascular disease, including myocardial infarction (heart attack), stroke, and invasive cardiovascular procedures.
To assess viremia, the authors examined six different measures, including current viral load, viral load before starting antiretroviral therapy (ART), the highest viral load category during ART, and several measures of cumulative exposure to viremia over time. These analyses were adjusted for many well-established cardiovascular risk factors included in the D:A:D CVD risk score, such as age, sex, smoking status, family history of CVD, diabetes, blood pressure, cholesterol levels, CD4 count, and exposure to specific antiretroviral drugs.
In initial analyses that did not account for other risk factors, some measures of viremia appeared to be associated with a higher risk of CVD. However, after adjusting for all established cardiovascular risk factors, no statistically significant association remained between any measure of viremia and CVD. This finding was consistent across all types of viremia measurements, including current, past, and cumulative viral load. Furthermore, viremia history did not make CVD risk estimates more accurate.
In conclusion, this large international study found that HIV viremia is not independently associated with CVD when established risk factors are considered. The results suggest that traditional risk factors remain the most important contributors to CVD risk among PWHIV.