What question did this study set out to answer?

To evaluate how previous major cardiovascular events (MACEs) and viremia influence the risk of new MACEs in people living with HIV on antiretroviral therapy.

February 2, 2026Open Access

Significant Impact of Previous Major Cardiovascular Events (MACEs) and Viremia on Risk of New MACEs in People Living with HIV on Antiretroviral Therapy

Key Points

To evaluate how previous major cardiovascular events (MACEs) and viremia influence the risk of new MACEs in people living with HIV on antiretroviral therapy.
Conducted a retrospective, single-center study on people living with HIV receiving ART.
Classified participants based on HIV-RNA levels: suppressed and various levels of viremia.
Used a Cox proportional hazards model for multivariate time-to-event analysis to assess associations with MACEs.
Followed 3349 individuals for a median of 14 years, with significant findings on viremia and MACEs.
300 MACEs were observed, with the highest incident rate among those with previous MACEs (HR 3.385).
Higher risks were found in patients with viremia > 1000 copies/mL at baseline (HR 2.209) and additional risk factors like age and metabolic conditions.

Abstract

Background: Major cardiovascular events (MACEs) in people with HIV (PWH) may be partly related to antiretroviral therapy (ART) and persistent inflammation. The aim of the study was to evaluate the association between targeted variables and MACEs. Methods: Retrospective, single-center study conducted on PWH receiving ART between January 2010 and April 2024, classified according to HIV-RNA levels: virological suppression ( 1000 copies/mL in 844 (25.2%). Overall, 300 MACEs occurred, including 53 (17.7%) repeated events, with total incident rate of 0.00976 events per person-year. The risk of MACEs was significantly associated with previous MACEs (Hazard Ratio, HR 3.385, p-value 1000 copies/mL at baseline (HR 2.209, p-value 0.039). Their onset was also significantly associated with greater age at baseline and years on ART, hypertension, diabetes, lower HDL, and higher triglycerides. Conclusions: PWH on ART with HIV-RNA > 1000 copies/mL at baseline and a previous MACE presented higher risk of developing MACEs.

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