Factors Affecting Risk of Cardiovascular Disease (CVD) Events in a Global CVD Prevention Cohort of People With Human Immunodeficiency Virus (HIV)

Background Persons with HIV face increased risks of major adverse cardiovascular events (MACE), partially mitigated by statin therapy. Methods We characterized factors associated with MACE and MACE subcomponents among PWH enrolled in REPRIEVE, globally. Our primary outcome measure was time-to-first primary MACE. Secondary outcome measures included time-to-first (1) hard MACE (cardiovascular disease [CVD] death, myocardial infarction [MI], or stroke), (2) MI, or (3) stroke. For each outcome, Cox proportional hazards models were used to estimate the hazard of baseline risk factors. Results Among participants (N = 7769), median age was 50 (Q1, Q3: 45, 55) years, and 31% were female. In fully adjusted models, risk of first MACE was higher for older individuals (50–59 and ≥60 vs 40–49 years; HR [95% CI]: 2.06 [1.54-2.76] and 2.53 [1.60-4.01]) and for those with Black/African-American race (vs White race, within HICs; HR: 1.65; 1.19-2.27), family history of premature CVD (HR: 1.53; 1.16–2.03), current cigarette smoking (HR: 2.27; 1.65-3.13), hypertension (HR: 1.77; 1.36-2.30), lower HDL cholesterol (HR: 1.21; 1.10-1.34), HIV-1 RNA ≥lower limit of quantification (LLQ) (HR: 1.40; 1.0-1.97), and a select antiretroviral therapy class combination (HR: 1.53; 1.01-2.31). Individuals from HICs had a higher risk of first MACE versus those from other regions, except South Asia. There was no apparent protective effect of female sex. Modeling for hard MACE, MI, and stroke yielded similar results for most variables. Conclusions Among PWH in REPRIEVE, select modifiable risk factors were associated with first MACE after accounting for statin effects. Female sex was not protective. Clinical Trials Registration NCT02344290 (ClinicalTrials.gov; date of initial registration: 22 January 2015).