Prevalence and risk of cardiovascular events among people living with HIV: a meta-analysis

Background People living with HIV (PLWH) have increased cardiovascular risk, but the contribution of HIV-related factors to all-cause cardiovascular events remains unclear. We assessed the prevalence and determinants of cardiovascular events in PLWH, including subtype-specific risk profiles.Methods PubMed, EMBASE, Cochrane Library, Web of Science and Scopus were searched from January 1, 2004 to October 31, 2024. Observational studies reporting cardiovascular event prevalence or adjusted risk estimates in PLWH were included. Two reviewers independently selected studies and extracted data. Pooled relative risks (RRs) and 95% confidence intervals (CIs) were calculated using fixed- or random-effects models, and heterogeneity was assessed using Cochran’s Q and I2 statistics.Results Forty-three studies including 4,175,459 PLWH and 166,225 cardiovascular events were analyzed. The pooled prevalence of cardiovascular events was 6% (95% CI: 0.05–0.07). Higher risk was associated with older age, smoking, antiretroviral therapy, male sex, CD4+ T-cell count <200 cells/mm3, detectable HIV viral load, dyslipidemia, hypertension, diabetes, syphilis coinfection, prior cardiovascular disease and elevated red cell distribution width. Higher CD4+ counts (per 100 cells/mm3) and Hispanic ethnicity were associated with lower risk. Subgroup analyses showed that smoking, antiretroviral therapy and dyslipidemia were linked to myocardial infarction; prior cardiovascular disease and CD4+ T-cell count <200 cells/mm3 to arrhythmia; and male sex, dyslipidemia, hypertension and syphilis coinfection to stroke.Conclusion PLWH have a substantial cardiovascular event burden driven by both traditional and HIV-related risk factors. Early cardiovascular risk assessment, viral suppression and immunological recovery should be prioritized.