Age-standardized comparison of cardiovascular events and all-cause mortality in people living with HIV and in general population

Abstract Background Antiretroviral therapy (ART) has improved the prognosis of HIV infection, but people living with HIV (PLWH) still experience disparities in life expectancy and comorbidities prevalence. Purpose This study aimed to compare the standardized incidence rates of atherosclerotic cardiovascular disease (ASCVD) and all-cause mortality between PLWH and the general population in Spain. Methods Two cohorts were included: the VACH cohort (PLWH) and the REGICOR cohort (general population). Participants aged 25-74 years without prior ASCVD were followed for a duration of 15 years. Baseline data on demographics, cardiovascular risk factors, and comorbidities were collected. Fifteen-year ASCVD incidence coronary artery disease (CAD) and stroke and all-cause mortality rates were standardized by age. Incidence of ASCVD and all-cause mortality were compared between the cohorts using the log-rank test and Cox proportional hazards models. All the analyses were stratified by sex and age groups (25-54, and 55-74 years). Results We included 10,218 general population participants and 6,829 PLWH. PLWH were 12 years younger, predominately male, and they had elevated triglyceride levels and a higher incidence of smoking compared to the general population. In contrast, they had lower levels of LDL cholesterol, total cholesterol, and BMI. Men with HIV aged 25-54 years had significantly higher ASCVD standardized incidence rates compared to men in the general population. No significant differences were observed in old men and young women in incidence rates. Both young men and women with HIV had significantly higher all-cause standardized mortality rates compared to the general population (Table 1). After adjusting for ASCVD risk factors, no significant difference remained in the risk of CAD and stroke among PLWH and the general population. However, the adjusted risk of all-cause mortality was 3-5 times higher in PLWH (Table 2). Conclusion The higher incidence of ASCVD among PLWH as compared to general population is explained by differences in the prevalence of risk factors. All-cause mortality risk in young PLWH, however, was almost three times higher that of general population.