Key result
Residual HIV viremia is linked to a ~180% higher risk of first cardiovascular events.
Why the study?
People with HIV using antiretroviral therapy have an increased risk of cardiovascular disease, leading researchers to investigate whether residual viremia further increases this risk.
Does residual viremia increase cardiovascular disease incidence in virally suppressed people with HIV?
Cohort (n=1,895)
Does residual viremia increase cardiovascular disease incidence in virally suppressed people with HIV?
Residual HIV viremia in virally suppressed patients is independently associated with a nearly 3-fold increased risk of incident cardiovascular events.
Residual viremia was associated with higher incident CVD in PWH on ART; leaves open whether targeting it improves outcomes.
BACKGROUND: People with HIV (PWH) using antiretroviral therapy are at increased risk to develop cardiovascular diseases (CVD). We hypothesized that residual viremia (RV; unquantifiable low, but detectable viral load) increases CVD risk. METHODS: We enrolled 1895 virally suppressed PWH and compared CVD incidence in participants with and without RV. Extensive multi-omics characterization was performed. Incident CVD was registered after 2-year follow-up and adjusted odds ratios (aOR) calculated accounting for classical CVD risk factors. The numbers of expected and actual CVD events were compared using CVD risk scores. FINDINGS: RV, detected in one-third of participants, strongly increased the risk of developing a first cardiovascular event (3.1% vs 1.2%, aOR 2.8, p=0.004). Participants with RV experienced twice the number of events predicted by the SCORE2 risk model. The association between RV and CVD was not driven by inflammation, immune activation, gut barrier dysfunction, or lipometabolic perturbations. INTERPRETATION: Residual viremia independently associated with CVD development, highlighting the need for tailored prevention and examination of novel intervention strategies.
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Otten et al. (2026) conducted a cohort in HIV (n=1,895). Residual viremia vs. No residual viremia was evaluated on First cardiovascular event (aOR 2.8, p=0.004). Residual viremia in virally suppressed people with HIV increased the risk of a first cardiovascular event compared to those without residual viremia (3.1% vs 1.2%; aOR 2.8; p=0.004).
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