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Projecting CVD risks in HIV-infected individuals in the US: competing risks and premature aging
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Reported by Jules Levin
CROI 2013
Elena Losina, PhD; Benjamin P. Linas, MD, MPH; Emily P. Hyle, MD; Corina Rusu, BA; Farzad Noubary, PhD; Bethany K. Berkowitz, BA; Paul E. Sax, MD;
Milton C. Weinstein, PhD; Andrea Ciaranello, MD, MPH; Rochelle P. Walensky, MD, MPH; Kenneth A. Freedberg, MD, MSc
Brigham and Women's Hospital, Boston, MA; Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA; Boston Medical Center, Boston, MA; Boston University School of Public Health, Boston, MA; Harvard School of Public Health, Boston, MA
Supported by: the National Institute of Allergy and Infectious Diseases and the National Institute on Drug Abuse (R01 AI058736, P30 AI060354, R01 AI093269, R01 DA031059, T32 AI007433-19, K01 AI078754)
This study assumes a "10-year shift due to 'premature aging'", so what does this mean. This study projects risk for CVD in HIV+ based on an assumption of premature aging, that HIV+ are 10 years ahead in the aging process compared to HIV-neg, that HIV+ are aging 10 years more quickly than HIV-negs. This assumption is based on studies that have been conducted. The projection in this study is that HIV+, both male & female, are at greater risk for CVD. This study looks at risk for CVD at ages 40, 50, and 60 in men & women and compares HIV+ with the US general population & HIV-uninfected at high risk for CVD. And as you can see their results are that they predict HIV+ men & women to be at greater risk than either comparator group at 40, 50 & 60.
You may want to also listen to the themed discussion session at CROI where this study gets a little presentation after the opening by Dr Monica Shah from the NIH Natl Heart, Lung & Blood Institute where she describes the NHLBU AIDS Working Group which met last Fall & outlined a collaborative project between the NIH & the HIV research community to conduct research on HIV & CVD, which I believe grew out of the growing sense of heart disease & all comorbidities as becoming increasing a serious problem, particularly as HIV+ individuals are aging and with the serious concern that HIV+ may be experiencing comorbidities at earlier ages than HIV-negs or more certainly that HIV+ are experiencing comorbidities at greater rates and that perhaps their is an affect of premature aging in HIV that could be based on immune activation & inflammation.
http://webcasts.retroconference.org/console/player/19433?mediaType=podiumVideo
Points by Dr Shah:
- by 2015, HIV patients aged 50 & older will account for >50% of HIV/AIDS cases.
- Chronic non-infectious diseases such as CVD are an increasing public health problem, with the increasing survival among HIV+ there has been an increase in non-AIDS comorbid conitions: non-AIDS related deaths account for 50.5%, with 16.6% due to CVD, 23.5% to non-AIDS malignancy, and 14.1% due to liver-related (data from 13 HIV cohorts 1996-2006; Antiretoviral Therapy Cohort Collaboration, CID 2010).
- risk of CVD in HIV vs non-HIV patients: RR 1.61, HIV no ART (61% increased risk); HIV on ART RR 2.0 (100% increased risk); Islam FM et al HIV Medicine 2012; 13: 453-68
RISK FACTORS
Complex Interplay between-
Conventional risk factors
- higher rates of smoking, dyslipidemia, hypertension, diabetes
- obesity
- renal disease
Cardio-metabolic adverse effects of ART
HIV infection
inflammation & immune activation: immune senescence, microbial translocation, persistent viral replication & production, chronic activation of the immune system & endothelium
link to Executive Summary of NHLBI AIDS Collaboration Working Group
http://www.nhlbi.nih.gov/meetings/workshops/AIDSworking.htm
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